What is the neonatal resuscitation sequence after birth if the infant’s heart rate remains below 100 after 30 seconds of stimulation?

• A. Start positive-pressure ventilation; if HR remains below 60 after quality PPV, perform chest compressions; if still below 60, give epinephrine
• B. Begin chest compressions immediately
• C. Give epinephrine first
• D. Place the infant in prone position and observe

Answer: (D)

When a newborn’s heart rate stays below 100 after 30 seconds of initial stimulation, the next step is to start positive-pressure ventilation right away. The goal is to improve oxygenation and ventilation to boost heart rate. Deliver breaths with a bag‑mask at about 40–60 breaths per minute, using an effective seal and ensuring adequate chest rise. Reassess the heart rate every 30 seconds during ventilation.

Chest compressions are not started immediately; they’re indicated only if the heart rate remains below 60 after about 30 seconds of effective ventilation and CPR with compressions at a 3:1 ratio. Epinephrine is reserved for persistent bradycardia despite CPR. Placing the infant in a prone position or simply observing would not address the need for ventilation and heart-rate support during this critical window.