Chest compressions are indicated during neonatal resuscitation when the heart rate:

• A. Remains below 100 bpm after 30 seconds of positive pressure ventilation
• B. Remains below 60 bpm after 30 seconds of positive pressure ventilation
• C. Remains below 60 bpm after 60 seconds of positive pressure ventilation
• D. Remains below 60 bpm after 30 seconds of positive pressure ventilation

Answer: (D)

In neonatal resuscitation, ventilation is started first, and chest compressions are added only if the heart rate remains under 60 beats per minute after about 30 seconds of effective positive-pressure ventilation. This timing reflects that once adequate ventilation hasn’t produced enough perfusion to sustain the heart and brain, circulatory support is needed. Waiting longer—such as 60 seconds—or waiting for a higher heart rate (like 100 bpm) would delay needed chest compressions. Therefore, the scenario where the heart rate stays below 60 after 30 seconds of PPV is the point at which chest compressions are indicated.