What is a key indicator to continue PPV until spontaneous effort is observed?

Continuing positive pressure ventilation (PPV) until spontaneous effort is observed is primarily indicated by the heart rate. A crucial threshold is a heart rate of at least 100 bpm. Achieving this heart rate signifies that the newborn's circulation and oxygenation are returning to adequate levels following resuscitation efforts.

When the heart rate is at least 100 bpm, it indicates an improvement in the newborn's condition, suggesting that the respiratory drive may also be returning. At this point, the risk of inadequate oxygenation decreases significantly, and the focus can shift toward monitoring for spontaneous breathing efforts.

In contrast, a heart rate below 60 bpm indicates a critical situation requiring immediate intervention, including continuing PPV, as this level of heart rate suggests severe hypoxia and compromised hemodynamics. A heart rate that is above 60 bpm but below 100 bpm may imply reduced effectiveness of resuscitation, meaning that while some improvement has occurred, it is not sufficient to stop PPV. Normal respiratory rates are important for assessing the newborn's respiratory function but are not the primary indicator for ceasing PPV. The focus during resuscitation is to stabilize hemodynamic function first, reflected in heart rate, before looking for independent respiratory efforts.