During labor, a patient was observed to have thick, green-colored amniotic fluid when her membranes ruptured spontaneously. Soon after the birth of her baby, the neonate had difficulty establishing respirations, appeared cyanotic, and had tachypnea and retractions. The nurse immediately responded to the neonate by ensuring which of the following priority interventions?

Intubate the infant and suction the meconium.


• When meconium aspiration occurs, intubation and immediate suctioning of the airway for no longer than 5 seconds is indicated. If heart rate is low, positive pressure ventilation is administered and suctioning is performed again later.

• If the infant has normal respiratory effort, tone, and heart rate over 100, intubation is not done and meconium is cleared from the mouth and nose with a bulb syringe or suction catheter.

• It was once recommended that the infant be suctioned by a bulb syringe as soon as the head is delivered, but the American Academy of Pediatrics no longer recommends this.

• Do not administer oxygen under pressure until the infant has been intubated and suctioned. This is so the oxygen pressure does not drive small plugs of meconium farther down into the lungs.

• After tracheal suction, infants may be treated with oxygen administration. Antibiotic therapy may be used to prevent the development of pneumonia.

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