Initial care supports warmth, breathing, and airway patency through drying, stimulation, positioning, and clearance of secretions when necessary.
Warmth, drying, and stimulation
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Place the neonate under a heat source, preferably a radiant warmer. Avoid covering the baby with blankets or towels so that the baby remains visible and radiant heat reaches the skin.
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Dry the neonate with pre-warmed linen and remove wet linen to prevent heat loss.
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Drying and suctioning can provide sufficient stimulation to initiate breathing. If breathing remains poor, gently rub the trunk, back, and extremities, without spending excessive time on tactile stimulation.
Airway positioning
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Place the neonate on the back or side with the neck slightly extended in the sniffing position.
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Avoid neck flexion and hyperextension because either may interfere with respiration.
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A rolled blanket or towel under the shoulders can elevate them by ¾ or 1 inch and help maintain positioning, particularly with a prominent occiput.
Clearing secretions safely
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If secretions are present, remove them by wiping the nose and mouth with a clean cloth or by using a bulb syringe or suction catheter.
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Suction the mouth before the nose to prevent aspiration if nasal suctioning provokes a breathing effort.
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For copious oral secretions, turn the head to one side so secretions collect where they can be removed easily.
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Use a 12 or 14 Fr suction catheter. Keep suction pressure around 80 mm Hg and no higher than 100 mm Hg.
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Avoid deep catheter insertion: posterior pharyngeal stimulation can produce a vagal response causing bradycardia or apnea.