When should chest compressions be initiated on a newborn?

• A. Start chest compressions immediately if heart rate is less than 60
• B. Institute PPV with 100% oxygen for 1 minute and if heart rate remains below 60 start chest compressions
• C. Wait 3 minutes before starting any resuscitation
• D. Use defibrillation first

Answer: (B)

In newborn resuscitation, improving breathing and oxygenation comes before chest compressions. Most newborn distress is due to inadequate ventilation, so the first step is to provide effective positive-pressure ventilation with 100% oxygen and reassess the heart rate after about a minute. If the heart rate remains below 60 beats per minute despite that ventilation, that’s the point to begin chest compressions while continuing ventilations. This sequence ensures oxygen reaches the heart and brain and that circulation is supported when needed.

Starting chest compressions right away when the heart rate is under 60 isn’t ideal because it delays establishing adequate ventilation. Waiting several minutes before acting would further delay crucial support, and defibrillation isn’t a routine first move in neonatal resuscitation unless there’s a specific shockable rhythm, which is not the typical scenario at birth.