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]

References19Show ledgerHide ledger

1. [1]Liley HG, Weiner GM, Wyckoff MH, et al. Neonatal Life Support: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations Circulation, 2025.PMID 41122846
2. [2]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
3. [3]Madar J, Roehr CC, Ainsworth S, et al. European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth Resuscitation, 2021.PMID 33773829
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9. [9]Halling C, Conroy S, Raymond T, et al. Use of Initial Endotracheal Versus Intravenous Epinephrine During Neonatal Cardiopulmonary Resuscitation in the Delivery Room: Review of a National Database J Pediatr, 2024.PMID 38631614
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11. [11]Seidler AL, Aberoumand M, Hunter KE, et al. Deferred cord clamping, cord milking, and immediate cord clamping at preterm birth: a systematic review and individual participant data meta-analysis Lancet, 2023.PMID 37977169
12. [12]Gomersall J, Berber S, Middleton P, et al. Umbilical Cord Management at Term and Late Preterm Birth: A Meta-analysis Pediatrics, 2021.PMID 33632933
13. [13]Tarnow-Mordi W, Morris J, Kirby A, et al. Delayed versus Immediate Cord Clamping in Preterm Infants N Engl J Med, 2017.PMID 29081267
14. [14]Jacobs SE, Berg M, Hunt R, et al. Cooling for newborns with hypoxic ischaemic encephalopathy Cochrane Database Syst Rev, 2013.PMID 23440789
15. [15]Kirpalani H, Ratcliffe SJ, Keszler M, et al. Effect of Sustained Inflations vs Intermittent Positive Pressure Ventilation on Bronchopulmonary Dysplasia or Death Among Extremely Preterm Infants: The SAIL Randomized Clinical Trial JAMA, 2019.PMID 30912836
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17. [17]Ramaswamy VV, Bandyopadhyay T, Nangia S, et al. Assessment of Change in Practice of Routine Tracheal Suctioning Approach of Non-Vigorous Infants Born through Meconium-Stained Amniotic Fluid: A Pragmatic Systematic Review and Meta-Analysis of Evidence outside Randomized Trials Neonatology, 2023.PMID 36754038
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19. [19]American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy Executive summary: Neonatal encephalopathy and neurologic outcome, second edition Obstet Gynecol, 2014.PMID 24785633