The baby does not breathe spontaneously and remains apneic after stimulation. The next intervention is to use mechanical ventilation.
Recent studies have indicated a worse neurological prognosis (increased frequency of peri-intraventricular hemorrhage, periventricular leukomalacia and/or death) in extremely low birth weight preterm newborns, on mechanical ventilation and who received morphine from the first hours of life until about 14 days. Such studies show an association of this poor outcome with the presence of hypotension prior to the opioid infusion. Therefore, in preterm newborns with birth weight less than 1,000 g, after careful assessment of the presence of pain and defining the indication for opioids, start its administration only if the patients are normotensive.
With this information, we can conclude that the babies in this situation need mechanical ventilation and/or resuscitation.
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