In neonatal resuscitation, what is the next step if the newborn’s heart rate remains below 60 after 30 seconds of chest compressions?

• A. Continue chest compressions only
• B. Administer epinephrine
• C. Stop resuscitation
• D. Give oxygen only

Answer: (B)

In neonatal CPR, a heart rate remaining below 60 after 30 seconds of chest compressions signals a perfusion problem that needs a pharmacologic boost. Epinephrine is given to raise coronary and cerebral perfusion by increasing systemic vascular resistance and improving perfusion pressure during CPR. It’s administered IV or IO (and can be given via the endotracheal tube if IV access isn’t yet established), while you continue chest compressions and ventilation. Repeat doses are given as needed every few minutes, with ongoing reassessment of heart rate.

Continuing chest compressions alone won’t address the perfusion deficit, stopping resuscitation isn’t appropriate with ongoing bradycardia, and giving oxygen alone doesn’t tackle the low perfusion that’s preventing ROSC.