In neonatal resuscitation, if the heart rate is less than 100 bpm after initial steps, what is the next step?

• A. BVM, SpO2, Cardiac Monitor
• B. Start CPR immediately
• C. Administer epinephrine
• D. Warm the baby more

Answer: (A)

The main idea here is that improving ventilation and oxygenation drives the heart rate in a newborn. When the heart rate is under 100 after the initial steps, the priority is to support breathing with positive-pressure ventilation. Using a bag-mask device to deliver effective breaths helps increase oxygen delivery and improves pulmonary perfusion, which often raises the heart rate. At the same time, attach and use a SpO2 monitor and a cardiac monitor to track how well the baby is ventilating and how the heart rate responds, guiding further actions.

Starting CPR immediately isn’t the next step unless the heart rate drops below 60 despite effective ventilation and initial interventions. Epinephrine is reserved for persistent bradycardia despite CPR, and warming the baby, while important, doesn’t address the immediate need to optimize ventilation in this scenario.