Immediately after birth, what should be done if the newborn is not breathing?

• A. Delay any intervention and observe for 5 minutes
• B. Provide positive-pressure ventilation with a bag-valve-mask after initial warming and drying
• C. Suction the airway before warming
• D. Begin chest compressions immediately

Answer: (B)

When a newborn isn’t breathing right after birth, the priority is to provide effective ventilation right away. After you’ve dried and warmed the baby and positioned the airway, delivering breaths with a bag-valve-mask is the next essential step. This helps inflate the lungs, improve oxygen delivery, and stimulate a return of breathing and a normal heart rate. The bag-valve-mask method is used because it directly addresses the lack of air entry into the lungs, which is the immediate problem in an apneic newborn.

Delaying intervention isn’t safe, since delaying ventilation allows oxygen deprivation to continue. Suctioning the airway isn’t routine before warming and drying and is reserved for specific airway issues or nonvigorous infants with obvious airway obstruction or meconium. Beginning chest compressions right away isn’t appropriate unless the heart rate remains very low (below about 60) after providing adequate ventilation for a short period. In most non-breathing newborns, establishing ventilation is the key first step.