Lund, Sweden

Neonatal Resuscitation

Clarity in Emergency Medicine




’Neonatal Resuscitation’ refers here to the systematic initial management of the newborn. This initial management is organized according to the ABCDE sequence. Assessments and treatments are carried out simultaneously.


  1. Initial Management

1-Dry the infant. The stimulation from drying the newborn is often enough to induce adequate breathing.

2-Assess breathing and tone. A child with vigorous regular breathing, normal tone and a heart rate > 100/min requires no other measures than preventing hypothermia.

3-Cord clamping should be delayed > 1 min if no resuscitation is required. The optimal timing of cord clamping if resuscitation is indicated is unknown.

  1. Airway

1-Head in neutral position: if resuscitation is required, place the newborn supine with the head in neutral position (a towel placed under the shoulders may be required).

2-Jaw-thrust or oropharyngeal tube may be required to open the airway.

3-Airway suctioning (12-14 FG) is only required if the newborn is non-vigorous and thick meconium is present.

  1. Breathing

1-Ventilate the newborn with bag-valve-mask using room air at a rate of 30/min (1 second for each inflation).  During the first 5 positive pressure inflations, maintain pressure for 2-3 sec.

2-Ensure that the chest passively rises with each inflation, otherwise reposition the airway and/or improve the seal of the mask.

  1. Circulation

1-Assess the heart rate using a stethoscope placed at the heart apex or an EKG.

2-Start chest compressions if the heart rate is < 60/min despite adequate ventilation:

  • encircling the chest with the hands, two thumbs on the lower third of the sternum

  • compression depth: 1/3 of the chest depth

  • 3:1 compressions:ventilations with each ”event” 0.5 seconds (90 compressions/min)

3-Check the heart rate every 30 seconds. Discontinue chest compressions when the heart rate is > 60/min.

  1. Drugs

If the heart rate remains < 60/min despite adequate ventilation and chest compresssions, consider administering the following via an umbilical vein catheter or intraosseous needle:

  • Adrenalin 1 mg/ml 10 µg/kg

  • Crystalloid or blood 10 ml/kg

  • Naloxone 1 mg/kg (can also be given intramuscularly)

  1. End

  • Consider terminating resuscitation if signs of life are absent despite > 15 min of resuscitation

  • Therapeutic hypothermia should be offered to newborns with evolving moderate – severe hypoxic-ischemic encephalopathy.