In neonatal resuscitation for a non-breathing newborn, what is the correct initial sequence?

• A. Intubate immediately and start chest compressions.
• B. Clear airway, dry, stimulate, and begin positive pressure ventilation; initiate CPR if heart rate remains below threshold.
• C. Give epinephrine before ventilation.
• D. Wait for spontaneous breathing before any ventilation.

Answer: (B)

In neonatal resuscitation, the priority is to establish ventilation and oxygenation for a non-breathing newborn. Clear the airway if needed, dry the infant to reduce heat loss, and stimulate to help initiate breathing. Then begin positive pressure ventilation immediately with a bag-mask device, and look for chest rise as a sign that ventilation is effective. If the heart rate remains below 60 beats per minute after about 30 seconds of effective ventilation, start chest compressions to support circulation. Epinephrine is not given before ventilation and chest compressions; it’s considered only after continued bradycardia despite those measures. Waiting for spontaneous breathing before starting ventilation isn’t appropriate; prompt ventilation is essential, with intubation reserved for situations where mask ventilation is ineffective.