A newborn born at 41 weeks gestation via emergent cesarean section for fetal distress is covered in thick green amniotic fluid. At delivery, the infant is limp, apneic, and bradycardic with heart rate 50 bpm. What is the immediate intervention according to Neonatal Resuscitation Program (NRP) guidelines?

Answer and explanation

Correct answer: C. Dry, stimulate, and initiate positive pressure ventilation (PPV)

  1. Step 1: Current NRP guidelines no longer recommend routine direct endotracheal suctioning for non-vigorous meconium-stained infants.
  2. Step 2: The initial priority for an apneic, limp, or bradycardic newborn is prompt drying, positioning, clearing secretions if obstructing, and initiating effective positive pressure ventilation (PPV) within the first 60 seconds of life.
  3. Step 3: Chest compressions are only initiated if heart rate remains < 60 bpm after 30 seconds of effective PPV with chest movement.
Answer
Dry, stimulate, and initiate positive pressure ventilation (PPV).
Why not the others: Routine tracheal suctioning delays life-saving ventilation; chest compressions are premature before establishing ventilation; epinephrine requires prior compressions.

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