In neonatal resuscitation, when should CPR be started?

• A. Immediately start chest compressions
• B. After establishing a pulse oximeter reading
• C. CPR should be started if heart rate remains below threshold
• D. CPR should be started immediately on all non-breathing newborns

Answer: (C)

In neonatal resuscitation, you first establish effective ventilation and monitor the heart rate. Start chest compressions when the heart rate remains below 60 beats per minute despite adequate ventilation. This threshold signals poor perfusion and the need for circulatory support. If the heart rate is above 60, you continue to optimize ventilation and monitoring rather than starting compressions. Pulse oximetry helps assess oxygenation but isn’t the trigger for initiating CPR. Non-breathing newborns aren’t automatically started on CPR; the decision hinges on the heart rate in relation to the ventilation being provided.