At 43 weeks' gestation, a long, thin infant is delivered. The infant is apneic, limp, pale, bradycardic, and covered with "pea soup" amniotic fluid. Which of the following is the best first step in the resuscitation of this infant at delivery?

Infants who are postdates (more than 42 weeks' gestation) and show evidence of chronic placental insufficiency (low birth weight for gestational age and wasted appearance) have a higher than average chance of being asphyxiated, and passage of meconium into the amniotic fluid places these infants at risk for meconium aspiration. Ideally the obstetrician suctions the mouth, nose, and hypopharynx immediately after delivery of the infant's head but before delivery of the reminder of the body. If the infant's heart rate is more than 100 beats per minute and respirations are unlabored, routine neonatal management is appropriate. However, if the heart rate is less than 100 beats per minute in a floppy, depressed infant then endotracheal intubation is accomplished along with suctioning and providing oxygen. Always consider airway, breathing, and circulation, in that order, before moving on.