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If these responses are absent or weak, brisk but gentle drying with a soft towel should be used to stimulate the infant to breathe [Class A, expert consensus opinion]. Note that for premature infants who are placed in/under a polyethylene bag/sheet to prevent evaporative heat http://www.selleckchem.com/products/DAPT-GSI-IX.html loss (see Guideline: The Resuscitation of the Newborn Infant in Special Circumstances), drying beforehand is unnecessary and potentially counterproductive, but tactile stimulation can be provided through the bag or sheet, if needed. In non-vigorous, meconium-exposed infants who are to be intubated to suction meconium from the trachea, the intubation should be done immediately and stimulation should be withheld until suction is completed (see Guideline: Airway Management and http://www.selleckchem.com/products/Adriamycin.html Mask Ventilation of the Newborn Infant) [Class B, expert consensus opinion]. Slapping, shaking, spanking, or holding the newborn upside down are potentially dangerous and should not be used. During all handling, care should be taken to ensure that the infant's head and neck are supported in a neutral position, especially if muscle tone is low[Class A, expert consensus opinion]. If the infant does not breathe, assisted ventilation should be started (see Guideline: Airway Management and Mask Ventilation of the Newborn Infant) [Class A, expert consensus opinion]. After initial breathing efforts the newborn infant may pause for a few seconds and should then establish regular breaths sufficient to maintain the heart rate more than 100 per minute. Breathing may be difficult to assess well in the first minute or two after birth. However, if the infant can maintain a heart rate >100/min, immediate intervention may not be required, apart from ensuring that head, jaw and neck position allow airway patency. If the heart rate is not maintained >100/min, positive pressure ventilation is required [Class A, expert consensus opinion]. Recession, retraction or indrawing of the lower ribs and sternum, or onset of persistent expiratory grunting are important signs that the baby is having difficulty expanding the lungs. If they persist, the infant may benefit from continuous positive airway pressure (CPAP) or positive pressure ventilation [Class B, expert consensus opinion]. Persistent apnoea, particularly associated with hypotonia http://www.selleck.cn/products/dabrafenib-gsk2118436.html (floppiness), and a heart rate