Neonatal resuscitation for the anaesthetist: NLS/NRP sequence and adrenaline dosing

Meet the patient

It is 0300. The category-1 caesarean for prolonged fetal bradycardia is already under way under general anaesthesia. The baby is handed up pale, floppy, and apnoeic. The neonatal registrar is three minutes away. You are the anaesthetist — and for those three minutes, you are the neonatal resuscitationist.[3]

The question that decides whether this baby recovers without brain injury is not what drug you reach for, but whether you can aerate the lungs effectively. Every step of the neonatal algorithm flows from that single insight, and forgetting it — reaching for adrenaline before you have moved the chest — is the mistake that fails vivas and harms babies.[1]

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1. [1]Aziz K, Lee HC, Escobedo MB, et al. Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Circulation, 2020.PMID 33081528
2. [2]Aziz K, Lee CHC, Escobedo MB, et al. Part 5: Neonatal Resuscitation 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Pediatrics, 2021.PMID 33087555
3. [3]Liley HG, Weiner GM, Wyckoff MH, et al. Neonatal Life Support: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations Resuscitation, 2025.PMID 41117580
4. [4]Mushambi MC, Kinsella SM, Popat M, et al. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics Anaesthesia, 2015.PMID 26449292