# Neonatal Resuscitation > Neonatal resuscitation for FMGE Obstetrics: 30-second cycles, PPV 40-60 per minute, compressions 3:1, epinephrine and volume doses. - Canonical URL: https://prepelephant.com/topics/fmge/obstetrics-and-gynaecology/neonatal-resuscitation-fmge - Exam / course: FMGE · Subject: Obstetrics and Gynaecology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Neonatal Resuscitation", PrepElephant, https://prepelephant.com/topics/fmge/obstetrics-and-gynaecology/neonatal-resuscitation-fmge ## Direct answer About 10 per cent of newborns need help to breathe at birth, roughly 1 per cent full resuscitation, and the algorithm runs on 30-second evaluation cycles: dry, warm, position and stimulate; if apnoeic, gasping or heart rate under 100, start positive-pressure ventilation at 40-60 breaths per minute (the single most important step); reassess at 30 seconds; if the heart rate stays under 60 despite effective ventilation, add chest compressions, two-thumb technique, 3:1 ratio (about 120 events per minute, depth one-third of the chest); reassess at 60 seconds; if still under 60, give epinephrine 0.01-0.02 mg/kg (0.1-0.2 mL/kg of 1:10,000) through an umbilical venous catheter, with normal saline 10 mL/kg for suspected hypovolaemia. Air (21 per cent oxygen) starts resuscitation in term babies, higher blends for preterm. ## What you must remember - **The evaluator quartet at every cycle:** respirations, heart rate (stethoscope or cord palpation), colour, tone — heart rate decides everything downstream. - **Ventilation is the manoeuvre:** most "flat" babies revive with effective positive-pressure ventilation alone — rate 40-60 per minute, peak pressure about 20-25 cm H2O, visible chest rise the endpoint; MRSOPA corrects a failing mask ventilation (mask reposition, reposition airway, suction, open mouth, pressure increase, alternate airway). - **Compressions:** two thumbs on the lower third of the sternum, hands encircling the chest; 3:1 ratio, 90 compressions plus 30 breaths totalling 120 events per minute; only for heart rate under 60 after 30 seconds of effective ventilation; coordinated, never simultaneous. - **Epinephrine:** 0.01-0.02 mg/kg IV — 0.1-0.2 mL/kg of 1:10,000 — via umbilical venous catheter, repeated every 3-5 minutes; 1:1,000 is never used intravascularly and the endotracheal route is no longer preferred. - **Volume:** normal saline or O-negative blood 10 mL/kg over 5-10 minutes for hypovolaemia (a pale baby still bradycardic despite ventilation), repeated once. - **Oxygen logic:** 21 per cent for term, 21-30 per cent under 35 weeks, titrated to preductal targets (60s at 1-3 minutes, 90s by 10 minutes). - **Special cases:** meconium — routine intrapartum and tracheal suction of non-vigorous babies are abandoned; suction only if obstruction limits ventilation; a preterm baby under 32 weeks gets proactive thermal care (plastic wrap, warmer). - **Withholding and stopping:** resuscitation is not initiated or is stopped where gestation or condition makes survival futile; an absent heart rate beyond 10 minutes of adequate resuscitation guides the discussion, with parents informed. ## Running the algorithm against the clock A term baby is born through thick meconium, limp and not crying. Within 30 seconds he is dried under a radiant warmer, positioned head-neutral and stimulated — he gives a gasp, then stays apnoeic with a heart rate of 70. Positive-pressure ventilation with air begins: mask seal chin-to-nose, 40-60 breaths per minute, chest rising visibly. Thirty seconds of ventilation and the heart rate is 80 — keep ventilating, no tracheal suction for meconium, no oxygen bump. Another thirty seconds: heart rate 110, spontaneous breaths — the entire resuscitation was ventilation, the lesson in one baby. The next baby, 30 weeks, apnoeic and bradycardic at 50 despite 30 seconds of effective ventilation with 30 per cent oxygen: compressions begin — two thumbs, 3:1, one-third depth, counted aloud "one-and-two-and-three-and-breathe". Sixty seconds later the rate is 45: the umbilical vein is catheterised and epinephrine 0.02 mg/kg given (a 1.4 kg baby gets 0.28 mL of 1:10,000) while ventilation and compressions continue; volume is reserved for the pale, shocked picture after abruption. The rate crosses 60, compressions stop, ventilation tapers. Had the rate stayed flat through 10 minutes of effective resuscitation, the conversation shifts to stopping — the hardest decision in the algorithm. ## Where students slip Three slips account for most lost marks: initiating compressions before ventilation is proven effective (the algorithm demands 30 seconds of effective positive-pressure first — "effective" means chest movement); the epinephrine arithmetic (1:10,000, 0.1-0.2 mL/kg intravenously — candidates pick 1:1,000 or the endotracheal habit of older editions); and the meconium reflex (tracheal suction for every meconium-stained baby is obsolete — the priority is ventilation). The ratio question (3:1, not 15:2 or 30:2) and the Apgar trap (resuscitation proceeds by heart rate and breathing, not the 1-minute score) complete the set. ## Frequently asked questions ### What is the first and most important step in neonatal resuscitation? Effective positive-pressure ventilation at 40-60 breaths per minute for any apnoeic or gasping baby or a heart rate under 100 — most respond to this alone. ### When are chest compressions started in a newborn? Only when the heart rate remains under 60 after at least 30 seconds of effective positive-pressure ventilation — coordinated 3:1 compressions to breaths, about 120 events per minute. ### What is the dose and route of epinephrine in neonatal resuscitation? 0.01-0.02 mg/kg intravenously — 0.1-0.2 mL/kg of 1:10,000 — through an umbilical venous catheter, repeated every 3-5 minutes; 1:1,000 is never given intravascularly. ### How is a meconium-stained newborn managed at birth? Routine tracheal suction is no longer done; dry and stimulate, ventilate if non-vigorous, and suction only if obstruction interferes with ventilation. ### What volume expansion is used for a shocked neonate? Normal saline (or O-negative blood after blood loss) at 10 mL/kg over 5-10 minutes, repeated once if the response is inadequate.