What is indicated when the heart rate is less than 60 bpm after initial resuscitation efforts?

When the heart rate is less than 60 beats per minute after initial resuscitation efforts, it indicates that the newborn is still experiencing significant distress and inadequate cardiac output. In such situations, the recommended intervention is to continue high-quality chest compressions, as they are essential in maintaining blood flow to vital organs during a cardiac or respiratory event. Additionally, administering epinephrine is crucial because it can help stimulate the heart and increase the chances of restoring an effective heart rate.

The combination of cardiovascular support through chest compressions and the pharmacological action of epinephrine works collaboratively to improve outcomes in neonates that are bradycardic (having a heart rate less than 60 bpm) even after initial resuscitative measures. This approach aligns with the guidelines outlined in the Neonatal Resuscitation Program, emphasizing the importance of ongoing intervention rather than ceasing efforts or attempting less effective strategies.