Call for help (NICU team).
Warm, dry and stimulate: place the newborn under a radiant warmer, wrap in warm towels, dry the skin and stimulate by rubbing with the towels.
Suction the mouth and nose only if obvious obstruction to breathing (if gasping or apneic, initiate positive pressure ventilation).
Check heart rate with a stethoscope and apply pulse oximetry to the right hand. A readily discernible heartbeat of 100 beats per minute or greater is the goal.
If heart rate is less than 100 beats per minute after 30 seconds, initiate positive pressure ventilation.
If heart rate <60 beats per minute despite adequate ventilation and oxygenation for 30 seconds, begin chest compressions. Consider intubation, especially if no chest rise with ventilation corrective steps.
If heart rate remains less than 60 beats per minute, establish an umbilical or IV line and initiate appropriate drug therapy (epinephrine).
Check blood sugar with heel stick glucose. Treat for hypoglycemia <40 mg/dL.