During delivery of a 41-week gestation infant with thick meconium-stained fluid and the infant limp in the OB arms, what is the first priority action?

• A. Vigorously dry the infant to prevent cold stress
• B. Suction the airway immediately
• C. Stimulate the infant to cry
• D. Initiate positive pressure ventilation

Answer: (A)

The first action is to vigorously dry the newborn to prevent cold stress. Thermal stability is crucial because hypothermia increases metabolic and oxygen demands and can worsen respiratory effort, especially in a term infant who is limp and has meconium-stained fluid. Drying quickly and placing the baby on a warm surface helps stabilize heart rate and breathing and sets the stage for proper evaluation and further steps.

After drying, assess breathing and tone. If the infant remains not breathing or limp, proceed with stimulation and, as needed, ventilation and airway management per resuscitation steps. In the context of thick meconium, airway suctioning becomes important, but warming and drying come first to minimize heat loss and buy time for appropriate airway and ventilation measures.