When is it necessary to suction an infant's mouth and nose?

Suctioning an infant's mouth and nose is primarily indicated to clear the airway, especially when there are potential obstructions like meconium, which can pose serious risks during the first moments of life. In the case of a lethargic infant where meconium is present, there's a crucial need to ensure that the airway is clear to facilitate effective breathing. Meconium can be thick and sticky, and if inhaled into the lungs, it can lead to meconium aspiration syndrome, which is a critical condition. Therefore, suctioning becomes a necessary procedure to prevent complications.

While suctioning immediately after birth may be a common practice in certain circumstances, it is not universally required for all infants, especially if there are no obstructions or risk factors present. Crying is a sign of an infant with an open airway and good respiratory function, eliminating the need for suctioning. Additionally, suctioning only in cases of respiratory distress could lead to delays in addressing airway management for infants at risk, especially when clear indicators, like the presence of meconium, are evident. Hence, suctioning in the presence of meconium and lethargy is the most critical and warranted scenario.