When should chest compressions be initiated in a neonate during resuscitation?

Chest compressions should be initiated in a neonate during resuscitation when the heart rate is below 60 beats per minute, despite effective positive pressure ventilation (PPV). This is based on critical guidelines in neonatal resuscitation that emphasize the importance of ensuring adequate circulation when there are signs of severe bradycardia.

In this scenario, the rationale for starting chest compressions at a heart rate below 60 bpm is to promote blood flow and oxygen delivery to vital organs when the heart's intrinsic rate is critically low, indicating that the neonate is unable to maintain adequate cardiac output on their own. Effective PPV can sometimes temporarily increase heart rate; however, if the heart rate remains below this threshold despite providing effective ventilation, the next step is to perform chest compressions to stimulate the heart and promote adequate blood circulation.

Other scenarios, such as the absence of breathing for more than 30 seconds or immediately after intubation, do not necessarily indicate the need for chest compressions based on the established protocols. The heart rate is the crucial indicator for initiating chest compressions during neonatal resuscitation, reaffirming the importance of monitoring it continuously during resuscitation efforts.