On Management of Neonatal Asphyxia

To the Editor.—  Drs Peterson and Gregory (241:1835, 1979) have asked and thoughtfully discussed whether a severely hypoxic newborn should be intubated immediately or ventilated with bag and mask.A third alternative is mouth-tomouth ventilation. The technique requires skill. The physician stands at the side of the baby's head. His hands must support and lift forward both angles of the baby's mandible. His mouth fits on the baby's opened mouth, with the leak from the baby's nose controlled by pressure from the side of the physician's face. The chest is observed to make sure it rises well during inflation.The physician usually wears a porous surgical mask, but the procedure can be done without an interposed mask. Either way, no time should be lost in starting ventilation.Preliminary suctioning ordinarily is omitted. There is little risk of aspiration, since mucus or meconium in the nasopharynx and nose is blown out