Neonatal resuscitation at birth

The baby is out and grey. Not crying, not moving, and the midwife is looking at you. Roughly 85% of babies breathe on their own within 30 seconds and need nothing from you at all — this one is not that baby. What separates a good registrar from a frightened one here is a sequence rehearsed until it is automatic, and the discipline to keep working on the lungs when instinct says do something dramatic.^[1][2]

Overview and definition

Two words you must use precisely at the station. Newborn means the infant in the first minutes to hours after birth; the neonatal period runs to 28 days. Newborn algorithms — including the 3:1 ratio — apply to the first group, and the ANZCOR Guidelines 13.1 to 13.10 are written for them.^[1][2]

Distinguish support of transition from resuscitation: ^[1][3]

• Support of transition — warmth, drying, stimulation, airway position, skin-to-skin, an intact cord. This is what most babies need, and doing more is doing harm.
• Resuscitation — positive pressure ventilation and above. Roughly 1 baby in 20 needs assisted ventilation; the number needing chest compressions or adrenaline is smaller by another order of magnitude.^[2][16]

RANZCOG C-Obs 32 (Responsibility for neonatal resuscitation at birth, November 2018 with an interim update February 2023) splits the skill set the same way, and it splits the staffing with it. First-response (basic) skills cover assessment, thermal care, airway positioning, mask and supraglottic airway ventilation, chest compressions and non-technical skills. Advanced skills add intubation, vascular access including emergency umbilical venous access, drugs and fluids, and needle decompression of a pneumothorax.^[1][2]

References20ShowHide

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4. [20]Resuscitation Council UK Newborn resuscitation and support of transition of infants at birth — 2025 guidelines Resuscitation Council UK, 2025.Source
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