Slipped capital femoral epiphysis — USMLE Step 2 CK MCQ

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ModeratePediatricsSlipped capital femoral epiphysisUSMLE Step 2 CK

A term newborn is delivered after an uncomplicated pregnancy. After birth, the infant is limp and apneic. The newborn is moved to a warmer, dried, positioned, and stimulated. At 30 seconds, there is still no respiratory effort and the heart rate by auscultation is 80/min. Which intervention should be performed next?

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Correct answer: D — Begin positive-pressure ventilation with a face mask

A newborn who remains apneic or gasping, or whose heart rate remains below 100/min after the initial warming, positioning, drying, and stimulation steps, needs positive-pressure ventilation within the first minute after birth. Effective ventilation is the most important intervention in neonatal resuscitation, and a rising heart rate is the best sign that it is working. A face mask is an appropriate initial interface; mask seal, airway position, and chest movement are reassessed if the heart rate does not rise. Additional stimulation would delay needed ventilation. Chest compressions are started only if the heart rate remains below 60/min despite at least 30 seconds of effective ventilation that moves the chest, generally after establishing an alternate airway. Epinephrine is considered when the heart rate remains below 60/min despite effective ventilation and coordinated compressions. Routine tracheal suctioning is not indicated in this uncomplicated delivery.

Reference: American Heart Association and American Academy of Pediatrics. 2025 Neonatal Resuscitation Guideline. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/neonatal-resuscitation