Table of contents
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 2021), and the American College of Obstetricians and Gynecologists (ACOG 2017).
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Diagnostic investigations
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 2021 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 2021 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
Follow-up and surveillance
Discontinuation of resuscitation: as per AHA 2021 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 2021 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