Establishing effective ventilation in the newborn is a complex physiologic process involving initiation of the first breath, removal of lung fluid, generation of enough pressure to inflate the lungs, and redistribution of blood flow. Most infants complete this process successfully with little-to-no assistance from medical personnel. However, nearly 10% of infants require some assistance to breathe after birth. Pediatricians must have the appropriate knowledge and skill to intervene and reduce the morbidity and mortality associated with ineffective neonatal ventilation.

The primary measure of adequate ventilation is a prompt increase in heart rate. An initial heart rate of less than 100 beats/min with absent, weak, or irregular respiratory effort indicates a need for rapid intervention. Although the Apgar score was developed to serve as a standardized assessment of an infant's clinical status after delivery, it should not be used as an indicator for the need for resuscitation. Most importantly, the initiation...

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