Initial Steps to Neonatal Resuscitation¹

Assess respirations, HR, and color

30 sec

• Temperature: provide warmth (dry; use radiant warmer)
• Airway: position on back or side, neck slightly extended in a "sniffing" position, and suction (mouth first, then nose)
• Dry, stimulate,^* reposition

^* Note: if meconium present and baby NOT vigorous, suction mouth and trachea first

If baby fails to improve (apnea, cyanosis, HR <100)

30 sec

• Breathing: positive pressure ventilation (PPV) at 40–60 breaths/min with 100% O₂ using infant BVM

If HR remains <60 bpm despite adequate ventilation/O₂

30 sec

• Circulation: chest compressions at 120 events/min (3 compressions with 1 ventilation every 2 sec)
• Drugs: reassess efforts, intubate, and administer drugs
• Epinephrine (1:10,000): 0.1–0.3 mL/kg IV (0.3–1 mL/kg ET)
• NS: 10 mL/kg IV, IO, or umbilicus over 5–10 min
• Naloxone: 0.1 mg/kg IV, IM (for respiratory depression despite PPV and maternal narcotic within last 4 hr)

Note: consider intubation at any step during resuscitation

¹ American Academy of Pediatrics (AAP), Neonatal Resuscitation Textbook, 5th edition, 2006 AAP, with permission.