B is the correct answer. Why?

Explanation

The American Academy of Pediatrics created and maintains a Neonatal Resuscitation Program providing evidence-based recommendations for the resuscitation of newborn infants. Infants who are term, breathing or crying, and have good tone can stay with the parent for ongoing evaluation. Those who are not term, breathing or crying, or do not have good tone should be warmed and stimulated and have their heart rate taken. If their heart rate is below 100 bpm or if the infant is apneic or gasping, positive pressure ventilation should be initiated. Most infants who do not do well on their own at birth will respond and recover quickly with effective positive pressure ventilation. The heart rate is the best indicator of response and usually will increase to well above 100 bpm with this step. If an infant does not respond well to positive pressure ventilation, the clinician should check for chest movement, reposition the patient, and check for mask fit to evaluate whether positive pressure ventilation is adequate. Corrective steps should be taken to ensure adequate oxygenation and ventilation. Sometimes this requires endotracheal intubation or a laryngeal mask airway and rarely requires tracheal suctioning or a needle decompression of a pneumothorax. Only after adequate ventilation fails to improve a newborn infant’s status are steps of chest compressions and an umbilical venous catheter recommended.

Chest compressions (A) should be performed when the heart rate drops below 60 bpm with adequate ventilation. Endotracheal intubation (C) is necessary when other corrective steps to ensure adequate ventilation fail. Sometimes endotracheal intubation is the corrective step needed to ensure adequate ventilation. An emergency umbilical venous catheter (D) is recommended after starting chest compressions so epinephrine can be administered intravenously.