Please read the following vignette and watch the video clip (Fig 1).A 38-2/7 weeks-gestation, growth-restricted infant is delivered through clear amniotic fluid after an otherwise uncomplicated pregnancy. Immediately after birth, the infant is warmed, dried, stimulated, and the team attempts to open the airway. Watch the following video segment; 30 seconds after birth, the heart rate is 90 beats per minute. Which of the following actions is most likely to result in an improvement in heart rate?Correct Response: b. Insert a 2.5-mm endotracheal tube through the noseVentilation is the most important intervention in neonatal resuscitation; a rise in heart rate is the most sensitive indicator of effective ventilation. In the video vignette, the infant has a very small mandible, which results in critical narrowing of the pharyngeal airway. The tongue is posteriorly displaced and falls back into the pharynx resulting in obstruction; the newborn presents with difficulty breathing immediately after birth. The Neonatal Resuscitation Program suggests the first approach to manage pharyngeal airway malformation is to place the infant prone. In the prone position the tongue usually falls forward, which opens the airway. If positioning is not successful, the next most effective means of opening the airway is to insert a 2.5-mm endotracheal tube into the nose (correct response b), with the tip located deep in the posterior pharynx past the base of the tongue but not into the trachea. This maneuver will often open the airway enough to allow adequate movement of air (Fig 2, adapted from the Neonatal Resuscitation Textbook, 6th edition). Chest compressions are not indicated at this stage of resuscitation. Ideally, ventilation is established before beginning chest compressions; in most circumstances, this means the infant should be intubated and a trial of positive pressure ventilation (PPV) with the endotracheal tube should be given. This infant needs effective PPV and that should be the focus at this stage of the resuscitation.Placing the infant in the side lying position is unlikely to be effective at relieving the airway obstruction. In the Neonatal Resuscitation Program, it is recommended that infants with signs of mandibular hypoplasia should be placed in the prone position.Repositioning the head and reapplying the mask will not improve ventilation in this scenario; the obstruction is caused by the tongue falling into the posterior pharynx.Stimulation is not going to be effective at this stage of resuscitation. Stimulating an infant in primary apnea will induce respirations; the infant in this vignette is demonstrating signs of progressive respiratory acidosis from airway obstruction.Efforts must be taken to optimize teamwork during crisis situations; when an infant is born with an airway anomaly, it is not uncommon for members of the resuscitation team to become fixated on the problem. In this vignette, the infant was dysmorphic and unable to breathe spontaneously. The team needed to quickly recognize the problem and prioritize the need for effective ventilation. Effective attention allocation allows teams to remain aware of the details, focused on the overall condition, avoid fixation errors, and prioritize the needs of the patient.