If a baby is not breathing after gentle stimulation in the first minute, what is the most appropriate next step?

The most appropriate next step for a baby who is not breathing after gentle stimulation during the first minute is to begin positive pressure ventilation (PPV) by mask. This intervention is critical because it helps to establish effective ventilation in a newborn who is not breathing adequately on their own, which is often a crucial step in resuscitation.

When a newborn fails to initiate breathing, they may require assistance to provide adequate oxygenation and prevent the potential consequences of hypoxia. Positive pressure ventilation by mask is a non-invasive way to support the baby’s breathing and helps to deliver oxygen directly to the lungs.

In this early stage, interventions such as chest compressions may not be necessary until basic ventilation is adequately addressed. IV fluids are typically not the immediate concern if the baby is not breathing; thus, they would not be the first line of treatment in this scenario. Intubation is reserved for cases where the airway needs to be secured, or if PPV is ineffective in restoring adequate ventilation. Since PPV is a preliminary step in managing a newborn not breathing, it is the appropriate first action.