During neonatal resuscitation, if heart rate is at 50 after 30 seconds of effective positive pressure ventilation, what should be the next step?

In neonatal resuscitation, a heart rate of 50 beats per minute after 30 seconds of effective positive pressure ventilation indicates a severely depressed heart rate, necessitating immediate action. Administering epinephrine is the correct option in this scenario.

Epinephrine is a critical medication used during resuscitation to stimulate the heart and improve cardiac output. It is indicated when the heart rate remains below 60 beats per minute despite effective ventilatory efforts. This is particularly important in the neonatal population, where the threshold for intervention is different compared to adults. Administering epinephrine can help restore a normal heart rate and improve the infant’s overall chances of survival.

In contrast, while chest compressions may eventually be needed if the heart rate does not improve, the priority at 50 beats per minute, given that ventilation has already been established, is to administer epinephrine to stimulate cardiac activity. Intubation is not usually the immediate next step unless ventilation is ineffective, and sodium bicarbonate is not indicated in this acute phase of resuscitation without established acidosis and is rarely used in the resuscitation of neonates. Thus, initiating epinephrine is the most appropriate and effective action at this juncture.