In an unresponsive infant with suspected severe airway obstruction, what is the first action the neonatal/pediatric specialist should take?

• A. Administer back blows
• B. Administer chest thrusts
• C. Administer abdominal thrusts
• D. Open the airway

Answer: (D)

Opening the airway is the first action because the immediate priority is to secure ventilation. In an unresponsive infant with suspected severe airway obstruction, you need to establish a patent airway so you can deliver rescue breaths without delay. If the airway isn’t open, no amount of blowing or chest manipulation will effectively oxygenate the tissues, and brain and heart injury can occur quickly.

To open the airway in infants, use a neutral head position with a gentle jaw-thrust as needed, then begin rescue breaths. The other maneuvers described are intended for conscious choking, where the infant can cooperate; they aren’t appropriate as the initial step when the infant is unresponsive because they can delay ventilation and potentially worsen obstruction or injury. After opening the airway and delivering breaths, assess responsiveness and circulation and proceed with CPR if indicated.