During resuscitation, what indicates a need for intubation in an apneic newborn?

In the context of resuscitating an apneic newborn, the indication for intubation is based on the effectiveness of ventilation techniques being employed. Continuous positive pressure ventilation (PPV) is often used as the initial intervention to help establish normal breathing. If there is no observable improvement in the newborn's condition with PPV—such as an increase in heart rate or re-establishment of spontaneous breathing—this indicates that the ventilation efforts are insufficient.

In this scenario, intubation is warranted to provide controlled ventilation directly into the trachea, which can help ensure adequate oxygenation and ventilation of the newborn. This is crucial in the critical moment of resuscitation to prevent potential hypoxic damage and to stabilize the infant's condition.

While stability in the heart rate, increased work of breathing, and the presence of meconium can influence the overall clinical picture and guide treatment, they do not directly indicate the immediate need for intubation as the lack of improvement with PPV does. Therefore, focusing on the efficacy of the current ventilation support is essential, and no improvement is a clear signal to escalate to intubation.