What are the initial steps in stabilization (newly born is preterm, not crying or breathing, does not have good tone)?
Because newly born infants do not tolerate cold, and hypothermia can prolong acidosis, heat loss should be prevented as much as possible. Dry the infant of the amniotic fluid and place the newborn in a slight Trendelenburg position, on his or her back with the neck slightly extended, under a prewarmed radiant warmer. Clean the airway, if necessary , with a bulb syringe or suction catheter. Do not suction more than 5 seconds and do not pass the tip farther than 5 cm. Vigorous suctioning will cause bradycardia. Therefore, if the amniotic fluid is clear and the newly born shows no signs of obstruction or need for positive-pressure ventilation, then suctioning, even with a bulb syringe, is not indicated. Usually by drying the infant, he or she is adequately stimulated to begin effective respirations. Avoid vigorous stimulation.
Meyer MP, Bold GT: Admission temperatures following radiant warmer or incubator transport for preterm infants < 28 weeks: A randomised study. Arch Dis Child Fetal Neonatal Educ 2007;92:F295-F297.