What is the first line intervention when a newborn is apneic at birth and does not improve initially?

When a newborn is apneic at birth, the primary and most immediate intervention is to start positive-pressure ventilation. This approach is critical because it helps to deliver oxygen directly to the lungs of the newborn, thereby facilitating gas exchange. When the infant is not breathing adequately on their own, providing positive pressure can quickly improve oxygenation and stimulate the respiratory drive.

In the context of newborn resuscitation, positive-pressure ventilation is typically initiated when a baby shows signs of not breathing or having a heart rate below a certain threshold. This intervention is designed to stabilize the infant and ensure that oxygen is supplied efficiently to essential organs, preventing potential complications associated with prolonged hypoxia.

Other options, while they may play a role in the broader context of resuscitation, are not the first-line responses. Administering normal saline wouldn't directly address the respiratory distress, and chest compressions are generally reserved for scenarios where there is ineffective circulation (usually indicated by a very low heart rate) rather than for initial respiratory distress. Additionally, while calling for additional help can be important in complex scenarios, immediate action to restore the infant's breathing is vital, making positive-pressure ventilation the immediate priority.