Paeds · fetal-neonatal-and-perinatal
Neonatal resuscitation and post-resuscitation stabilisation
Also known as Newborn resuscitation · Delivery-room resuscitation · Neonatal life support · NRP algorithm · Post-resuscitation stabilisation of the newborn
Fellowship guide to neonatal resuscitation and post-resuscitation stabilisation: anticipation, the first-minute assessment, positive-pressure ventilation, chest compressions, adrenaline and volume, temperature and glucose control, cord management, and safe referral for therapeutic hypothermia.
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Target exams
Red flags
- Newborn apnoeic or gasping after warmth, drying and stimulation
- Heart rate under 60 beats per minute despite effective ventilation
- No chest rise despite corrective MR SOPA steps — airway or technique problem
- Persistent bradycardia after 60 seconds of effective ventilation
- Term infant needing resuscitation with pallor, poor perfusion or blood loss suggesting hypovolaemia
- Meconium-stained liquor with a non-vigorous infant
- Hyperthermia or hypothermia after resuscitation — both worsen brain injury
- Moderate or severe encephalopathy in an infant of 36 weeks or more — cooling clock is running
Life stages
Care settings
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Board mappings
- Fetal and neonatal physiology and adaptation at birth
- Immediate newborn assessment and resuscitation
- Recognition and management of the acutely unwell neonate
- Neonatal resuscitation algorithm, ventilation and adrenaline
- Stabilisation and retrieval of the sick newborn
- Post-resuscitation care including temperature, glucose and cooling referral
- Applied neonatal physiology and transition
- Neonatal resuscitation doses, thresholds and equipment
- Team and human factors in neonatal emergencies
- Long case: preterm or asphyxiated newborn stabilisation
- Communication with the family after an unexpectedly difficult birth
- Neonatology: neonatal resuscitation
- Respiratory and cardiovascular compromise in the newborn
- Family-centred care after perinatal emergencies
- Neonatal physiology, transition and resuscitation
- Pharmacology: adrenaline and volume in the newborn
- Evidence-based neonatal guidelines
- Neonatal resuscitation scenario station
- Communication: difficult news after birth
- Neonatal resuscitation and stabilisation
- Newborn transition and thermoregulation
- Neonatal pharmacology: adrenaline and fluids
- Patient Care: neonatal resuscitation and stabilisation
- Medical Knowledge: fetal-to-neonatal transition and asphyxia
- Systems-Based Practice: regional retrieval and cooling referral
- Medical Expert: neonatal resuscitation
- Collaborator: multidisciplinary delivery-room team
- Health Advocate: perinatal system readiness
Overview & Definition
A baby is born, blue and limp. The clock has started, the team has seconds, and the decisions you make in the first minute shape the rest of that child's life. Neonatal resuscitation is the structured set of actions used at birth to help a newborn establish normal breathing and circulation when spontaneous transition fails. It is not adult cardiopulmonary resuscitation scaled down — the problem at birth is almost always the lung, not the heart, and the sequence of the algorithm reflects that. [1] [3]
The goal is to support transition — the shift from fetal placental gas exchange to air breathing. In fetal life the lungs are fluid-filled, the pulmonary vessels are tightly constricted, and blood shunts right-to-left through the foramen ovale and ductus arteriosus. The first breaths clear fluid, replace it with air, and drop pulmonary vascular resistance; the shunts then close as systemic resistance rises. When aeration fails, the whole circuit stays fetal, the baby stays hypoxic, and the heart slows. That single mechanism — failed aeration — is why ventilation is the first and most powerful intervention, and why most "resuscitations" are really the work of getting the lung aerated. [2] [4]
The distinction that matters at the bedside is between routine care (warmth, drying, stimulation, and observation), assisted transition (positive-pressure ventilation to establish breathing), and advanced resuscitation (compressions, adrenaline, volume). The algorithm forces you up that ladder only when the heart rate fails to respond, and it brings you back down the moment it does. [1]
References11ShowHide
- [1]Aziz K Part 5: Neonatal Resuscitation 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics, 2021.PMID 33087555
- [2]Madar J European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth. Resuscitation, 2021.PMID 33773829
- [3]Wyllie J European Resuscitation Council Guidelines for Resuscitation 2015: Section 7. Resuscitation and support of transition of babies at birth. Resuscitation, 2015.PMID 26477415
- [4]Perlman JM Part 7: Neonatal Resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation, 2015.PMID 26472855
- [5]McDonald SJ Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev, 2013.PMID 23843134
- [6]Duley L Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev, 2019.PMID 31529790
- [7]Katheria A Association of Umbilical Cord Milking vs Delayed Umbilical Cord Clamping With Death or Severe Intraventricular Hemorrhage Among Preterm Infants. JAMA, 2019.PMID 31742630
- [8]Askie LM Association Between Oxygen Saturation Targeting and Death or Disability in Extremely Preterm Infants in the Neonatal Oxygenation Prospective Meta-analysis Collaboration. JAMA, 2018.PMID 29872859
- [9]Azzopardi DV Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med, 2009.PMID 19797281
- [10]Niles DE Incidence and characteristics of positive pressure ventilation delivered to newborns in a US tertiary academic hospital. Resuscitation, 2017.PMID 28411062
- [11]Hoyle ES Quality improvement programme to increase the rate of deferred cord clamping at preterm birth using the Lifestart trolley. Arch Dis Child Fetal Neonatal Ed, 2020.PMID 32350065