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the posterior pharynx, larynx, and trachea to facilitate air entry This maneuver may also be accomplished by placing a towel or blanket beneath the upper back of the supine infant Avoid flexion or hyperextension of the newborn’s neck, which is likely to exacerbate airway obstruction Suctioning If needed, clear secretions with a bulb syringe or suction catheter Many newborns have excessive secretions related to amniotic fluid, cervical mucus, or meconium Suctioning may cause bradycardia or apnea; additionally, excessive suctioning may contribute to atelectasis Therefore, suctioning is reserved for the newly born infant whose airway appears obstructed or if PPV is required Meconium-Stained Fluid Management of meconium-stained amniotic fluid has changed substantially over the last two decades Approximately 2% to 5% of infants born with meconium in the amniotic fluid will experience some degree of aspiration syndrome, ranging from mild tachypnea to very severe pneumonitis with persistent pulmonary hypertension ( Fig 9.18 ) Vigorous infants with good spontaneous respiratory effort and muscle tone who are born through meconium-stained amniotic fluid may receive routine postnatal care with the parents Gentle clearing of meconium from the mouth and nose may be accomplished with a bulb syringe Infants with inadequate respiratory effort and poor muscle tone should be moved to a radiant warmer bed and initial resuscitation steps initiated Begin PPV for apnea or HR less than 100/min following initial steps Routine intubation for tracheal suction in the setting of meconium-stained amniotic fluid is not recommended Appropriate intervention to support oxygenation and ventilation of these infants should be initiated as clinically indicated, and may include intubation and suction if the airway is obstructed