In neonatal resuscitation, what is the initial step when the newborn is apneic with a heart rate >60 bpm?

• A. Stimulate the newborn
• B. Provide ventilation with bag-mask ventilation and reassess
• C. Start chest compressions
• D. Administer epinephrine

Answer: (B)

The main action here is to establish ventilation to restore oxygen delivery. When a newborn is apneic but has a heart rate above 60, the priority is to provide positive-pressure ventilation with a bag-mask device to inflate the lungs and improve oxygenation and perfusion. After about 30 seconds of effective ventilation, reassess the baby’s heart rate and breathing. If the heart rate remains below 60 despite adequate ventilation, escalate to chest compressions with ventilation and consider epinephrine. Stimulating alone does not correct the underlying ventilation problem, so ventilation is the best first step in this scenario.