Meconium aspiration is done for 3 times but no breathing occurs. Next step in resuscitation would be –
To solve this question, one should know the resuscitation protocol of newborn.
Resuscitation protocol

As soon as the baby is delivered, five signs are assessed -


Clearance of meconium
Active breathing or crying
Good muscle tone (flexed posture and active movement of baby).
Pink color (look at tougue and lips)
Term gestation (delivery between 37-42 weeks of pregnancy).


If all signs are positive no active resuscitation is required.
If any of the 5 signs is absent, baby requires resuscitation.
The baby should be placed under the heat source (radiant warmer) and subjected to a set of intervention known as initial steps.

Initial steps of resuscitation
1. Positioning

The neonate should be placed on her back or side with the neck slightly extended.
This can be achieved by putting a rolled blanket or towel under the shoulders, elevating them 3/4 or 1 inch off the mattress.

2. Suctioning

The mouth and nose should' be suctioned
The mouth is suctioned first to ensure that there is nothing for the infant to aspirate when the nose is suctioned.
One should not insert the catheter very deep in mouth or nose for suction ---> Stimulation of posterior

pharynx during the first few minutes after birth can produce a vagal responce, causing severe bradycardia or apnea.
3.Dry, stimulate and reposition
a After suctioning, the baby should be dried by using pre-warmed linen to prevent heat loss.

A brief tactile stimulation in the form of flicking the soles or rubbing the back may be provided in case of non-establishment of ood res irator efforts.

4. Free flow of oxygen

If the baby continues to be depressed, provide free flow of oxygen using a facemask.
After providing initial steps, the baby should be evaluated for three signs -


Respiration
Heart rate (HR)
Color


If baby has good breathing, HR >100 and pink color, he should be given supportive care.
If the baby is not breathing well or HR <100 then bag and mask ventilation is needed.
After the infant has received 30 seconds of ventilation with 100% oxygen by bag and mask, evaluation of heart rate should be done -

HR>100       --->          Discontinue ventilation if spontaneous respiration is present
HR 60 to 100 -->        Continue ventilation
Below 60     -->           Continue ventilation + chest compressions

After 30 seconds of chest compressions, the heart rate is checked.

BR< 60        -p            Continue chest compression and bag & mask ventilation + initiate medications.
BR > 60 Discontinue chest compression but continue bag & mask ventilation until the heart rate is above 100.
Chest compression
O2 inhalation
Bag & mask intubation
Trikling of sole