A baby is born with meconium stained liquor which of the following is taken account of in terming a baby vigorous except –

Resuscitation of neonate born through meconium-stained liquer (MSL) When baby passes meconium in utero, there is a chance that the mecomium will be aspirated into infant's mouth and potentially into the trachea and lungs. Appropriate steps must be taken immediately after delivery to reduce the risk of serious consequences resulting from aspiration of meconium. Intrapartum nasopharyngeal suctioning just after the delivery of head is no longer recommended as it does not reduce the risk of meconium aspiration syndrome and, on rare occasions, may cause nasophagngeal trauma or a cardiac arrhythmia. The first step after delivery is to identify whether the newborn is vigrous or non-vigrous : - A) Vigrous newborn A newborn is classified as vigrous, if he has all the three signs are present : - Strong respiratory effort Good muscle tone Heart rate greater than 100 The vigrous child does not require any tracheal suctioning and the usual initial steps of resuscitation are provided, i.e., provide warniith, positioning, suctioning of mouth and nose (not tracheal suctioning); Dry, stimulate and 02 if necessary. B) Non-vigrous newborn If any of the above three signs is present, the newborn is classified as non-vigrous. For non-vigrous child, the initial steps are modified : - Place the baby under radiant wanner and postpone suctioning to prevent stimulation of posterior pharyngeal wall that can cause bradycardia. Residual meconium in the mouth and posterior pharynx should be removed by suctioning under direct vision using a laryngoscope. The trachea should then be intubated and mechonium suctioned from the lower airway. Tracheal suctioning is best done by applying suction directly to the endotracheal tube. After providing initial steps, the further management is same as with resucitation for other conditions.