For a premature newborn delivered with no signs of life and gestational age less than 24 weeks, what is the CPR guideline?

• A. Begin chest compressions immediately
• B. CPR need not be initiated
• C. Ventilate with high-flow oxygen
• D. Administer epinephrine

Answer: (B)

When a newborn is extremely premature and has no signs of life, resuscitation is not initiated. Infants born before about 24 weeks have an extremely low chance of survival, and attempting CPR in this situation is unlikely to change the outcome, so the guideline is to refrain from starting CPR and provide appropriate comfort measures, with the hospital team contacted for further decisions. If there are signs of life or if gestational age is at or beyond that threshold, resuscitation should be started according to neonatal resuscitation guidelines (including warmth, drying, airway support, and ventilation as indicated) with medical control guidance.