At 42 weeks gestation, a long, thin neonate is born. He is apneic, pale with HR 94 bpm and covered with “pea soup” amniotic fluid. Which of the following is the first step in the resuscitation at delivery?

**Core Concept**
The scenario describes a newborn with signs of fetal distress, likely due to meconium aspiration syndrome, given the "pea soup" amniotic fluid. This condition requires immediate attention to establish adequate ventilation and oxygenation.

**Why the Correct Answer is Right**
The first step in resuscitating a newborn, especially one suspected of having meconium aspiration syndrome, involves clearing the airway to prevent further meconium aspiration and to facilitate effective ventilation.

**Why Each Wrong Option is Incorrect**
**Option A:** Incorrect because it doesn't address the immediate need to clear the airway.
**Option B:** Incorrect as it might not be the first step before ensuring the airway is clear.
**Option C:** Incorrect because, although important, it is not the initial step in resuscitation when meconium is present.

**Clinical Pearl / High-Yield Fact**
In meconium-stained neonates, especially those who are depressed or apneic, the priority is to clear the airway before starting ventilation to avoid pushing meconium further into the lungs.

**Correct Answer:** D. Suctioning the airway to remove meconium.

✓ Correct Answer: A. Aificial ventilation with bag and mask