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Nursing QUESTION #9145
Question 1
A newborn is delivered and assessed at birth. Resuscitation is initiated. After 30 seconds of effective positive pressure ventilation (PPV), heart rate is 55 bpm. What is the NEXT step according to Neonatal Resuscitation Program (NRP) guidelines?
  • Continue PPV alone for another 60 seconds
  • Begin chest compressions at ratio 3:1 (compressions: ventilation)✔️
  • Administer epinephrine 0.1 mg/kg IV immediately
  • Intubate the trachea and provide 100% oxygen via ETT only
Correct Answer Explanation

Neonatal Resuscitation Program (NRP) — Algorithm:

  1. Initial steps (warm, dry, stimulate, position, clear airway) — 30 seconds
  2. Assess: breathing, HR
  3. HR \(<100\,\text{bpm}\) or apnea → Start PPV with 21% O₂ (room air) for 30 seconds
  4. After 30 sec PPV: Reassess HR
    • HR \(\geq 100\): Continue PPV, wean O₂
    • HR \(60{-}99\): Ensure effective ventilation (MRSOPA), continue PPV
    • HR \(<60\) after 30 sec effective PPV → Start chest compressions + PPV
  5. Chest compressions:
    • Technique: 2-thumb encircling (preferred) or 2-finger method
    • Ratio: 3 compressions : 1 ventilation (90 compressions + 30 breaths = 120 events/min)
    • Depth: \(\frac{1}{3}\) of AP chest diameter
  6. After 60 sec compressions + PPV: If HR still \(<60\) → Epinephrine (IV preferred: \(0.01{-}0.03\,\text{mg/kg}\) of 1:10,000 solution)

Note: Adult CPR ratio is 30:2, but neonatal is 3:1 because neonatal arrest is usually respiratory in origin.