Neonatal Resuscitation

Publication Date: November 16, 2023
Last Updated: January 19, 2024

Top 10 Take-Home Messages for Neonatal Resuscitation

  1. For term and late preterm newborn infants ≥34 weeks’ gestation who do not require resuscita-tion, delayed cord clamping (≥30 seconds) can be beneficial compared with early cord clamping (<30 seconds).
  2. For term and late preterm newborn infants ≥34 weeks’ gestation who do not require resuscitation, intact cord milking is not known to be beneficial com-pared with delayed cord clamping (≥30 seconds).
  3. For nonvigorous term and late preterm newborn infants (35–42 weeks’ gestation), intact cord milking may be reasonable compared with early cord clamp-ing (<30 seconds).
  4. For preterm newborn infants <34 weeks’ gesta-tion who do not require resuscitation, delaying cord clamping (≥30 seconds) can be beneficial com-pared with early cord clamping (<30 seconds).
  5. For preterm newborn infants between 28 and 34 weeks’ gestation who do not require resuscitation and in whom delayed cord clamping cannot be per-formed, intact cord milking may be reasonable.
  6. For preterm newborn infants <28 weeks’ gesta-tion, intact cord milking is not recommended.
  7. Effective positive-pressure ventilation is the priority in newborn infants who need support after birth.
  8. Using a T-piece resuscitator to deliver positive-pressure ventilation is preferred to the use of a self-inflating bag.
  9. Because both T-piece resuscitators and flow-inflating bags require a compressed gas source to function, a self-inflating bag should be available as a backup in the event of compressed gas failure when using either of these devices.
  10. Use of a supraglottic airway may be considered as the primary interface to administer positive- pressure ventilation instead of a face mask for new-born infants delivered at ≥34 0/7 weeks’ gestation.

Term/Late Preterm Newborn Umbilical Cord Management

For term and late preterm newborn infants ≥34 weeks’ gestation who do not require resuscitation, delayed cord clamping (DCC) (≥30 seconds) can be beneficial when compared to early cord clamping (<30 seconds). (IIa, B-R)
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For nonvigorous term and late preterm infants (35–42 weeks’ gestation), intact cord milking may be reasonable when compared to early cord clamping (<30 seconds). (IIb, B-R)
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For term and late preterm newborn infants ≥34 weeks’ gestation who do not require resuscitation, intact cord milking is not known to be beneficial when compared to DCC (≥30 seconds). (III - No Benefit, C-LD)
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Preterm Newborn Umbilical Cord Management

For preterm newborn infants <34 weeks’ gestation who do not require resuscitation, delaying cord clamping (≥30 seconds) can be beneficial when compared to early cord clamping (<30 seconds). (IIa, B-R)
573
For preterm newborn infants between 28 and 34 weeks’ gestation who do not require resuscitation and in whom DCC cannot be performed, intact cord milking may be reasonable. (IIb, B-R)
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For preterm newborn infants <28 weeks’ gestation, intact cord milking is not recommended. (III - No Benefit, B-R)
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Devices Used to Administer PPV for Newborn Infants

It can be beneficial to use a T-piece resuscitator instead of a self-inflating bag, with or without a positive end-expiratory pressure valve, for administering positive-pressure ventilation to newborn infants, particularly for preterm infants. (IIa, B-R)
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Interfaces Used to Administer PPV for Newborn Infants

It may be reasonable to use a supraglottic airway as the primary interface to administer PPV instead of a face mask for newborn infants delivered at ≥34 0/7 weeks’ gestation. (IIb, C-LD)
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Recommendation Grading

Overview

Title

Neonatal Resuscitation

Authoring Organizations

American Academy of Pediatrics

American Heart Association

Publication Month/Year

November 16, 2023

Last Updated Month/Year

August 29, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This 2023 focused update to the neonatal resuscitation guidelines is based on 4 systematic reviews recently completed under the direction of the International Liaison Committee on Resuscitation Neonatal Life Support Task Force. Systematic reviewers and content experts from this task force performed comprehensive reviews of the scientific literature on umbilical cord management in preterm, late preterm, and term newborn infants, and the optimal devices and interfaces used for administering positive-pressure ventilation during resuscitation of newborn infants. These recommendations provide new guidance on the use of intact umbilical cord milking, device selection for administering positive-pressure ventilation, and an additional primary interface for administering positive-pressure ventilation.

Inclusion Criteria

Male, Female, Infant

Health Care Settings

Emergency care, Hospital

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Treatment

Diseases/Conditions (MeSH)

D015931 - Intensive Care, Neonatal

Keywords

neonatal respiratory distress, neonatal, late preterm, preterm, term

Source Citation

Yamada NK, Szyld E, Strand ML, Finan E, Illuzzi JL, Kamath-Rayne BD, Kapadia VS, Niermeyer S, Schmölzer GM, Williams A, Weiner GM, Wyckoff MH, Lee HC. 2023 American Heart Association and American Academy of Pediatrics Focused Update on Neonatal Resuscitation: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics. 2023 Nov 16. doi: 10.1542/peds.2023-065030. Epub ahead of print. PMID: 37970665.