In what scenario should CPAP not be used during resuscitation?

Continuous Positive Airway Pressure (CPAP) is a valuable intervention in neonatal resuscitation, particularly for managing respiratory distress. The scenario where CPAP should not be used is when the heart rate is below 100 beats per minute. This is because a heart rate that falls below this threshold indicates a potentially more severe state of compromise in the infant, such as inadequate cardiac output or significant respiratory distress requiring different interventions.

When an infant's heart rate is below this critical level, it suggests that the baby may require greater resuscitation efforts beyond CPAP, such as ventilation support or more aggressive resuscitation techniques. In such situations, the priority shifts to stabilizing the infant's cardiovascular condition and ensuring effective gas exchange, rather than applying CPAP, which is intended for use in infants who are spontaneously breathing and do not exhibit severe bradycardia.

In contrast, spontaneous breathing, the inability to maintain adequate oxygen saturation, and a heart rate over 100 bpm are indicators that CPAP could be beneficial in providing necessary respiratory support without interfering with more critical interventions that may be required due to bradycardia.