After initial steps of resuscitation have been completed, proper management of a newborn born through meconium stained amniotic fluid with depressed respirations and poor muscle tone includes:

• A. Continuous positive airway pressure if the heart rate is less than 100
• B. Endotracheal intubation if the heart rate is less than 100
• C. Positive pressure ventilation if the heart rate is less than 100
• D. Bronchodilator therapy if the heart rate is less than 100

Answer: (C)

When a newborn has depressed respirations and poor muscle tone, the priority after initial steps is to ensure effective ventilation. A heart rate below 100 beats per minute indicates inadequate ventilation/oxygenation, so initiating positive pressure ventilation is the most appropriate next move. This supports delivery of adequate tidal volumes and improves both oxygenation and perfusion, which often helps raise the heart rate toward normal.

Endotracheal intubation is reserved for situations where ventilation remains inadequate after adequate bag-mask ventilation, or for specific airway management needs—not as the first action when the primary issue is poor breathing with a low heart rate. Bronchodilator therapy isn’t part of standard neonatal resuscitation. CPAP is used when the infant is breathing spontaneously but still has respiratory distress or hypoxemia; it’s not the initial step when the heart rate is under 100 and ventilation is the main problem. In meconium-stained fluid, current guidelines emphasize establishing ventilation first rather than routine airway suctioning, reserving suctioning for specific airway obstructions if needed.