Current guidelines recommend initiating chest compressions when the heart rate is less than 60 beats per minute after 30 seconds of effective ventilation. Neonates receiving chest compressions are at high risk for mortality and poor neurodevelopmental outcome. While chest compressions provide circulatory support, its efficacy in neonatal bradycardia secondary to its asynchronous nature to the existing cardiac rhythm remains unknown and could be deleterious. Addressing neonatal asphyxia with adequate ventilation could reduce the need for chest compressions and improve overall outcomes.

The pilot study suggests that optimizing ventilation and avoiding chest compressions for bradycardia in neonatal resuscitation could reduce the need for chest compressions and improve gas exchange in an ovine model. With these data, the researchers intend to evaluate lowering the cut-off to initiate chest compressions for neonatal bradycardia for heart rates less than 30 beats per minute versus less than 60 beats per minute using both term and preterm models of bradycardia.

"Most neonates transition successfully at birth and establish normal breathing with lungs as the site of gas exchange," said Mausma Bawa, MD, fellow physician at Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo. "Neonates who require extensive resuscitation are at higher risk of morbidity and mortality. Currently, International Liaison Committee on Resuscitation (ILCOR)/Neonatal Resuscitation Program (NRP) recommends initiating chest compressions when the heart rate is less than 60 after 30 seconds of effective positive pressure ventilation through a properly secured advanced airway. Since there is no evidence for this current practice, our study evaluates the current recommendations. Our pilot study using a term ovine model suggests that focusing on ventilation for bradycardia during neonatal resuscitation could reduce the need for chest compressions."