In the setting of a full-term birth with maternal opioid exposure and the infant with poor tone, what is the next action after initial steps?

• A. Give naloxone
• B. Intubate the infant
• C. Provide positive pressure ventilation
• D. Begin chest compressions

Answer: (C)

The main idea is that restoring ventilation takes priority in a term newborn with suspected opioid-related respiratory depression and poor tone. The immediate next action is to provide positive pressure ventilation to support oxygenation and ventilation. Use a bag–valve–mask and deliver breaths at a rate that achieves visible chest rise and adequate ventilation, reassessing the infant’s heart rate and tone after a short trial.

Opioid exposure often suppresses respiratory effort, so giving effective breaths helps overcome that depression and improves perfusion. If after adequate ventilation the heart rate remains under 60, you would escalate to chest compressions with ventilation. Intubation and more invasive airway management are considered if ventilation remains ineffective or prolonged, but they are not the first step once you’ve started positive-pressure ventilation.

Naloxone is not the next action in the immediate resuscitation sequence because the priority is to establish effective ventilation first; reversing opioids can be considered later in specific circumstances and under careful supervision, but it should not replace the initial ventilation efforts.