Optimizing Chest Compressions for Bradycardia during Neonatal Resuscitation

ABSTRACT The result of birth asphyxia is a huge burden on global health contributing to 1 million neonatal death each year. The current recommendations by the neonatal resuscitation program (NRP) to provide external chest compressions when a newborn’s heart rate remains below 60 beats per minute after providing effective external breaths for 30 seconds. This protocol is based on expert opinion, but not evidence. The objective of this proposal is to determine the heart rate range for starting external chest compression to optimize blood flow to the brain and the heart. Low heart rate at birth in a newborn is normally due to impaired gas exchange, and our preliminary studies show that performing external chest compressions (CC) could be harmful when the heart is still beating. We hypothesize that continuing external breaths for low heart rate (