What action should the neonatal/pediatric specialist take when a post-term neonate is born with weak respiratory efforts and a heart rate of 58/min?

In the case of a post-term neonate exhibiting weak respiratory efforts and a heart rate of 58 beats per minute, initiating positive pressure ventilation with a face mask is a critical and appropriate response. When a newborn demonstrates inadequate respiratory effort, especially with such a low heart rate, it signals a need for immediate intervention to ensure adequate oxygenation and stabilization of the infant.

Positive pressure ventilation serves to support the neonate's respiratory drive until more definitive measures, if needed, can be taken or until their own efforts improve. In this scenario, the primary goal is to restore effective ventilation quickly, as prolonged hypoxia can lead to serious complications, including neurological impairment or death.

Meanwhile, although clearing the airway is also important, especially if there is an obstruction, the immediate priority in the context of weak respiratory effort is to provide ventilation. Other methods, such as suctioning with a bulb syringe or large suction catheter, may be appropriate in cases of clear airway obstruction but would not be sufficient alone to address the severity of the situation where ventilation support is critical.

The option involving inserting an endotracheal tube and attaching a meconium aspirator might be useful in situations where meconium aspiration is a concern; however, this is not the immediate first step