2010 Guidelines for Neonatal Resuscitation: Does the Algorithm Require a Clarification?

We read with interest the Kattwinkel et al1 article on the 2010 Guidelines for Neonatal Resuscitation. As the Neonatal Resuscitation Study Group of the Italian Society of Neonatology, we are currently in the process of updating the national neonatal resuscitation programs according to the 2010 Guidelines for Neonatal Resuscitation. While reviewing the above-mentioned article, an issue came to our attention that we believe deserves clarification. In the figure, at the bottom of the neonatal resuscitation algorithm, in case of a negative answer (no) to the question “HR below 60?” the arrow sends the reader to the box “Consider intubation, Chest compressions, Coordinate with PPV”. To our knowledge, when the heart rate is above 60 bpm, chest compressions are never indicated. Furthermore, this part of the algorithm is different from that proposed by Perlman et al2 and could lead to misinterpretation. Therefore, we suggest that this part of the algorithm be changed by shifting the arrow to the previous box of the figure (“HR below 60? No”).