Neonatal resuscitation at birth — structured oral station (12 minutes)

Opening prompt — "Talk me through what you do from the warmer."

Model response — say it in this order: ^[1][2]

• "I start the clock and call for the neonatal team. I assign a scribe and named roles."
• "I assess tone, breathing and heart rate: this baby is limp, apnoeic, heart rate 70. He needs ventilation."
• "I warm, dry briskly, remove the wet towel, position the head neutral with a shoulder roll, and begin positive pressure ventilation in air, attaching the oximeter to the right hand. I aim to have effective ventilation established by one minute."^[1]

Examiner is listening for: parallel action, ventilation as the priority, air (not oxygen) at term, oximeter on the right hand. ^[1]

Probe 1 — "What ventilation settings are you using?"

• "Room air at term, peak inflation pressure 30 cm H2O, PEEP 5 cm H2O, at 40 to 60 per minute with an inspiratory time of 0.3 to 0.5 seconds. I use the least pressure that moves the chest."^[1][3]
• "My preductal target at 5 minutes is 80 to 90%; a baby at 65% at two minutes is transitioning normally."^[1][4]

Probe 2 — "At 30 seconds of ventilation the heart rate is 45 and the chest is moving well. What now?"

• "The threshold for compressions is a heart rate under 60 despite 30 seconds of effective ventilation that visibly moves the chest — this baby meets it. I start two-thumb compressions on the lower third of the sternum at 3:1, increase oxygen to 100%, and simultaneously prepare umbilical venous access and adrenaline."^[1]
• "Adrenaline 10 to 30 microgram/kg intravenously, that is 0.1 to 0.3 mL/kg of 1:10,000, repeated every 3 to 5 minutes while the heart rate stays under 60."^[1][6]

Probe 3 — "Why air and not 100% oxygen?"

• "The systematic reviews found a mortality advantage for air over 100% oxygen at term; air is the starting point, with oxygen titrated only if saturations lag the target band despite effective respiratory support. Hyperoxia is not free."^[1][5]

Probe 4 — "The parents are frightened and watching. What do you say?"

This is a scored domain, not a courtesy. Demonstrate it out loud: ^[1]

• Move to their level, use the mother's name: "Your baby needed some help to start breathing. We have a team here and he is responding. I will keep you informed."
• Acknowledge fear, allocate a staff member to stay with them, avoid jargon and avoid conducting the conversation with your back turned.
• Commit to a debrief once the baby is stable.^[1][2]

Probe 5 — "The heart rate is now 130 and he is crying. What happens next?"

• "Admit to the neonatal unit — he needed compressions. Take paired cord gases, check a blood glucose within the first hour, assess for therapeutic hypothermia if encephalopathic, and keep him normothermic."
• "Document a contemporaneous timeline with times, doses and routes, debrief the team, and speak with the parents again in plain language today."^[1][2]