Neonatal resuscitation is the series of steps taken to help a newborn who is not breathing well or has a low heart rate immediately after birth. The purpose is to establish effective breathing, support circulation, and ensure the infant transitions safely to life outside the womb. These steps follow a structured, time-sensitive process because every second matters in the first minute of life.

Why it matters

Most babies begin breathing on their own, but about one in ten needs some form of assistance, and a smaller number need active resuscitation. Quick, coordinated action during this “golden minute” greatly improves survival and reduces the risk of brain injury and other complications.

The standard sequence

1. Preparation and assessment

Before delivery, a trained team reviews risk factors and prepares equipment. Immediately after birth, they quickly assess the baby’s tone, breathing, and heart rate.

2. Initial steps

Provide warmth, dry the infant, gently stimulate, and position the head to open the airway. Clear secretions only if they are blocking breathing. If the newborn is term and breathing well, routine care continues on the mother’s chest.

3. Ventilation

If breathing is poor or the heart rate is below 100 beats per minute, start positive-pressure ventilation (PPV) using room air for term babies or a slightly higher oxygen concentration for preterm babies. Effective ventilation is the single most important part of neonatal resuscitation. If the chest does not rise, adjust the mask seal, reposition the head, or consider inserting an airway device.

4. Circulation support

If, after 30 seconds of effective ventilation, the heart rate remains under 60, begin chest compressions while continuing ventilation. Compressions are given in a ratio of three compressions to one breath, with reassessment every 30 seconds.

5. Medications and fluids

If the heart rate stays low despite proper ventilation and compressions, give epinephrine through an umbilical venous line. In rare cases where blood loss is suspected, volume expansion with intravenous fluid may be required.

6. Post-resuscitation care

Once the baby stabilizes, focus shifts to maintaining normal temperature, blood sugar, and breathing. The newborn is monitored closely, and the team reviews what went well and what can improve next time.

Oxygen use

Resuscitation usually begins with room air for term infants and slightly higher oxygen for preterm infants. The goal is to match oxygen levels to safe targets while avoiding both low and excessive oxygen.

Cord management

If the newborn is stable, delaying cord clamping for 30 to 60 seconds improves circulation and iron stores. When immediate resuscitation is needed, cord management depends on the team’s setup and the infant’s condition.

Who performs it

Every delivery should have at least one person trained in neonatal resuscitation and ready to act. The most critical skill is effective ventilation, as most compromised newborns recover once the lungs are properly inflated.

Summary

Neonatal resuscitation is the emergency care provided in the first moments after birth to help a baby breathe and stabilize. The process follows clear priorities:

• Warm, dry, and stimulate
• Support breathing with ventilation if needed
• Begin compressions and give medication if the heart rate stays low
• Monitor recovery and provide ongoing care

The entire focus is to give the newborn the best possible start in life through rapid, organized, and skillful support.