A preterm infant with an apnea monitor experiences an apneic episode. Which action should the nurse implement first?

• A. Ventilate with an Ambu bag.
• B. Perform nasal and airway suctioning.
• C. Administer supplemental oxygen.
• D. Gently rub the infant's feet or back.

Answer: (D)

When a preterm infant has an apneic episode, the initial action is to stimulate breathing with gentle tactile stimulation. A quick rub to the feet or the back can wake the respiratory center and prompt a new breath without delaying care with more invasive measures. This noninvasive step is appropriate first because many brief apneic events in prematurity resolve with stimulation alone. After stimulating, reassess for breathing and heart rate and color. If apnea continues or the infant remains bradycardic or cyanotic, proceed to further support such as opening the airway and providing ventilation with a bag-valve-mask device and giving oxygen as needed. Suctioning should be reserved for evidence of secretions or airway obstruction, not as the first response.