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Neonatal resuscitation

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Updated 2023 AHA/AAP guidelines on neonatal resuscitation.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of neonatal resuscitation are prepared by our editorial team based on guidelines from the American Heart Association (AHA/AAP 2024), the International Liaison Committee on Resuscitation (ILCOR 2022), the American Heart Association (AHA 2020), and the American College of Obstetricians and Gynecologists (ACOG 2017)....
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Diagnostic investigations

HR assessment: as per ILCOR 2022 guidelines, Consider obtaining an ECG, when resources permit, for HR assessment in infants requiring resuscitation in the delivery room.
C
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Respiratory support

Airway clearing
As per ILCOR 2022 guidelines:
Avoid performing suctioning of clear amniotic fluid from the nose and mouth at birth as a routine step.
D
Consider performing airway positioning and suctioning if airway obstruction is suspected.
E

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  • Noninvasive positive pressure ventilation

  • Supplemental oxygen

Medical management

Vascular access
As per AHA 2020 guidelines:
Prefer the umbilical vein in infants requiring vascular access at the time of delivery.
B
Consider using the intraosseous route if intravenous access is not feasible.
C

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  • Volume resuscitation

  • Epinephrine

Nonpharmacologic interventions

Temperature management: as per ILCOR 2022 guidelines, Consider maintaining the room temperature of 23 °C at birth in order to maintain a normal temperature in late preterm and term infants (≥ 34 weeks gestation).
C
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  • Tactile stimulation

Therapeutic procedures

CPR: as per AHA 2020 guidelines, Consider initiating chest compressions if the HR after birth remains at < 60/minute despite adequate ventilation for at least 30 seconds.
C
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  • Umbilical cord clamping

  • Umbilical cord milking

Specific circumstances

Patients with meconium aspiration syndrome: as per ACOG 2017 guidelines, Do not perform intrapartum suctioning in infants with meconium-stained amniotic fluid, regardless of whether they are vigorous or not.
D
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Follow-up and surveillance

Discontinuation of resuscitation: as per AHA 2020 guidelines, View non-initiation of resuscitation and discontinuation of life-sustaining treatment during or after resuscitation as ethically equivalent.
B
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  • Post-resuscitation care

Quality improvement

Pre-resuscitation preparation: as per AHA 2020 guidelines, Ensure that every birth is attended by at least 1 specialist able to perform the initial steps of neonatal resuscitation and initiate positive pressure ventilation, and whose only responsibility is the care of the newborn.
B
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  • Health professional training