Intubation for tracheal suctioning is no longer recommended for vigorous or depressed
newborns with meconium-stained amniotic fluid.

Newborns in distress, as evidenced by poor respiratory effort or heart rate less than 100
beats/min, should be treated in a stepwise fashion with stimulation, positive pressure
ventilation, chest compressions, intubation, and medications.
Apnea, obstructive or central, is defined as at least a 20-second pause in respirations.

Low risk criteria for BRUE include age > 60 days, corrected gestational age > 45 wks, first
BRUE, no CPR required by a trained health care provider, no worrisome physical
examination findings and no features on history of concern (e.g. possible child abuse, family
history of sudden death or toxic exposures).

Recommendations for management of low risk infants encourage shared decision making
with the family and providers should not order extensive testing or admission solely for cardio-
respiratory monitoring.