# A nurse is caring for a newborn immediately after delivery. Which action should the nurse prioritize first to ensure the newborn's safety and prevent complications?

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> language: ko  
> subject: Maternal Newborn Health

## 문제

A nurse is caring for a newborn immediately after delivery. Which action should the nurse prioritize first to ensure the newborn's safety and prevent complications?

## 보기

1. Administer vitamin K injection to prevent hemorrhagic disease
2. Apply identification bands and footprint the newborn
3. Clear the airway and establish effective breathing **✔ 정답**
4. Clamp and cut the umbilical cord immediately

**정답: 3**

## 해설

Establishing a clear airway is the highest priority (ABCs) to ensure oxygenation, as other interventions like vitamin K, identification, or delayed cord clamping can wait until breathing is effective.

## 심화 해설

Clinical Reasoning and Prioritization

The correct answer is to clear the airway and establish effective breathing. In the immediate care of a newborn, the highest priority is always the establishment of a patent airway and effective ventilation. This principle is rooted in the foundational resuscitation sequence, which prioritizes airway (A) and breathing (B) before circulation (C) or other interventions. The transition from fetal to neonatal life is a critical physiological event where the newborn must rapidly clear fetal lung fluid and initiate air breathing to facilitate gas exchange. Failure to do so leads to hypoxia, the most common and immediate threat to a newborn's survival and long-term neurological outcome.

The provided 2025 Korean CPR guidelines [1] reinforce this systematic approach. While the abstract focuses on the guideline update process, it inherently validates the structured, evidence-based sequence of resuscitation, which begins with airway and breathing support. This is the universally accepted standard of care. The study on sustained lung inflation (SI) [2] further underscores the primacy of respiratory support in the delivery room. This randomized controlled trial investigated an advanced airway technique for preterm infants showing signs of respiratory distress, even those not initially requiring positive pressure ventilation. The very existence of this research highlights that the clinical focus in the first minutes of life is on optimizing lung aeration and respiratory function to prevent downstream morbidities and mortality. The intervention is centered on the "B" step of the ABCs, confirming that respiratory management is the immediate clinical priority.

Other actions, while important, are secondary to establishing ventilation. Administering vitamin K, applying identification bands, and clamping the cord are all time-sensitive but not immediately life-preserving. A newborn who is not breathing will not benefit from these interventions. The physiological basis for airway clearance is also supported by the research on mucociliary transport  and mucus homeostasis . These studies explain the mechanism by which the airway clears fluid and particles. At birth, the newborn's airway must transition from a fluid-filled to an air-filled state. Effective clearance of this fluid, driven by mechanisms like mucociliary transport which is influenced by particle (or fluid) size  and a balanced mucus gel layer composed of MUC5AC and MUC5B , is essential for successful air entry. The nurse's initial action of positioning the infant, suctioning the mouth and then the nose, and providing tactile stimulation directly supports these physiological clearance mechanisms to establish the first breath.References (research sources)

- [1]2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 1. The update process and highlights.GuidelineChung SP, Kim DK, Kim TY, Sohn Y, Shim G, Jung YH, Oh Y, Youn CS, Lee MJ, Lee J, Lee CH, Jang Y, Jang YS, Cho GC, Cha KC, Heo JS, Hwang SO. (2026) · DOI: 10.15441/ceem.26.071

- [2]Sustained Lung Inflation in Preterm Infants with Signs of Respiratory Distress: A Randomized Controlled Trial.RCT/clinical trialMohammadizadeh M, Moeini M, Barekatain B. (2026) · DOI: 10.4103/abr.abr_526_23

## 임상 시나리오

Clinical Practice Guide: Immediate Newborn Care

Upon delivery, the nurse's immediate priority is to ensure a patent airway and effective breathing. Follow this sequence:

- **Position and Clear Airway:** Place the newborn under a radiant warmer, position the head in a neutral or slightly extended 'sniffing' position. Suction the mouth first, then the nares gently with a bulb syringe or suction catheter to prevent aspiration.

- **Stimulate and Assess Breathing:** Dry the newborn thoroughly with a warm blanket, which provides tactile stimulation to initiate breathing. Simultaneously, assess respiratory effort, heart rate, and color. If the newborn is crying, it indicates a patent airway and effective breathing.

- **Provide Respiratory Support if Needed:** If the newborn is apneic, gasping, or has a heart rate below 100 bpm, initiate positive pressure ventilation (PPV) with a bag-mask device using room air. Ensure a proper mask seal over the mouth and nose.

- **Maintain Warmth and Delay Cord Clamping:** Keep the newborn dry and covered to prevent hypothermia. In vigorous newborns, delayed cord clamping for at least 30-60 seconds is recommended to improve iron stores, provided the airway and breathing are stable.

- **Proceed with Routine Care:** Once the newborn is stable (breathing well, heart rate over 100 bpm, pink color), proceed with identification bands, vitamin K injection, eye prophylaxis, and anthropometric measurements.

**Key Safety Alert:** Never suction deep or vigorously, as this can cause vagal stimulation leading to bradycardia. Always have emergency equipment (warmer, oxygen, bag-mask, suction) ready and checked before every delivery.

## 핵심 개념

- **Neonatal Resuscitation Sequence** — A systematic approach prioritizing Airway, Breathing, and Circulation (ABCs) to manage the newborn's transition to extrauterine life.
- **Fetal Lung Fluid Clearance** — The physiological process where fluid in the fetal lungs is replaced by air after birth, essential for initiating effective gas exchange.
- **Hypoxia** — A condition of inadequate oxygen supply to the tissues, which is the most immediate threat to a newborn if breathing is not established.
- **Patent Airway** — An open and unobstructed respiratory tract, which is the foundational first step in any resuscitation effort.
- **Positive Pressure Ventilation** — A method of assisted breathing used in newborns who are not breathing effectively on their own after initial airway clearance and stimulation.

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