Which of the following is NOT an indication for resuscitation in a newborn?

• A. Apgar score of one
• B. primary apnea
• C. heart rate of 60/min
• D. ventricular septal defect

Answer: (D)

In newborn resuscitation, actions are guided by the baby’s breathing and perfusion right after birth. The situation is judged by how well the infant is breathing, color, tone, and especially heart rate, with specific thresholds guiding steps.

A very low Apgar score at 1 minute indicates significant distress and signals the need to initiate resuscitation efforts to support breathing and circulation. If the newborn is not breathing or is depressed and not perfusing well (primary apnea), stimulation and ventilation are required to restore effective respiration. A heart rate that remains very low, around 60 beats per minute, reflects severe bradycardia and inadequate perfusion, so resuscitation is escalated—first with ventilation and, if necessary, chest compressions if the rate does not improve after ventilation.

A ventricular septal defect, on the other hand, is a structural heart defect that may be identified after birth but does not by itself mandate resuscitation at birth. Resuscitation decisions are driven by the newborn’s current respiratory status and heart rate, not by a congenital lesion unless that lesion is causing immediate hemodynamic instability.