B is the correct answer

The principles of neonatal resuscitation differ from the resuscitation of infants. The distinction is the complications that newborns experience as they transition from intrauterine to extrauterine life, which differ from those of infants who have been born for even a few hours. Fortunately, most term infants only need to be dried, warmed, and stimulated. A small percentage will need positive pressure ventilation, and a rare minority will need significant resuscitation. Unfortunately, infants that present newly born to the emergency department are more likely to have high-risk deliveries, such as trauma-induced labor or unexpected pregnancies. If the infant is term, vigorous, breathing, and crying, they can be reunited with their mother but should be reevaluated frequently. Many clinicians will at least dry, warm, stimulate, and provide gentle suctioning to the infant before reuniting them.

 

Unlike infant resuscitation, if there is gasping, respiratory distress, or a heart rate of < 100 bpm, the first step is positive pressure ventilation. Standard practice has recently changed with studies showing improved survival for newborns resuscitated with room air compared to 100% oxygen. A pulse oximeter should be applied if administering oxygen or positive pressure ventilation. In normal cases, newborns are expected to have a slow rise in their oxygen saturation, only reaching 85–90% at 10 minutes of life. Oxygen may be administered but blended with room air and only to reach age (in minutes)-appropriate goals. Of the above options, 21% oxygen or room air is the best initial choice for positive pressure ventilation.

The rule for neonates < 35 weeks gestation is slightly different, with a recommended initial oxygen saturation between 21 and 30% oxygen (C).

 

50% oxygen (D) is not recommended but may be needed in certain cases to reach age-appropriate goals.

 

100% oxygen (A) is recommended if the neonate remains bradycardic after 90 seconds or if chest compressions are required.

 

References:

1. Fernandes CJ. Neonatal resuscitation in the delivery room. Post TW, ed. UpToDate. UpToDate Inc. Accessed August 15, 2020.
2. Myers SR, Schinasi DA, Nadel FM. Cardiopulmonary resuscitation. In: Shaw KN, Bachur RG, eds. Fleisher & Ludwig’s Textbook of Pediatric Emergency Medicine. 7th ed. Philadelphia, PA: Wolters Kluwer; 2016:27–54.