Which resuscitation step is most appropriate for a neonate with poor respiratory effort but a heart rate above 100 bpm?

• A. Positive pressure ventilation
• B. Chest compressions
• C. Defibrillation
• D. End-tidal CO2 monitoring only

Answer: (A)

When a newborn has poor respiratory effort but a heart rate above 100, the priority is to support ventilation with positive pressure ventilation. The adequate heart rate shows circulation is present, so there’s no need for chest compressions yet. Use a bag‑valve‑mask or other PPV device to deliver breaths at about 40–60 per minute, making sure the chest clearly rises with each breath. Reassess the heart rate and respiratory status after a short trial; if ventilation improves and the heart rate stays above 100, continue PPV until breathing stabilizes. Defibrillation isn’t indicated here because there’s no shockable rhythm to treat, and chest compressions are reserved for when the heart rate remains below 60 after a period of effective ventilation. End-tidal CO2 monitoring can help confirm that ventilation is effective, but it doesn’t replace the need to provide breaths.