Newborn · Birth Resuscitation
Newborn Resuscitation (NRP / NLS)
What happens if your baby needs help breathing at birth. ~10% need some help; ~1% extensive resuscitation. NRP/NLS protocol: warm-dry-stimulate, assess, PPV, compressions if needed. UK ResusCouncil / ILCOR.
Last reviewed 2 June 2026
Neonatal resuscitation (NRP 8th ed)
Interactive walk-through
Next step
Initial rapid assessment (within seconds of birth)
- Term gestation?
- Good muscle tone?
- Crying or breathing?
Answer the three questions to start.
NRP minute-specific SpO2 targets (right hand)
- 1 min: 60–65 %
- 2 min: 65–70 %
- 3 min: 70–75 %
- 4 min: 75–80 %
- 5 min: 80–85 %
- 10 min: 85–95 %
Educational tool only — not medical advice. AHA/AAP NRP 8th Edition (2021); ILCOR Neonatal Life Support 2020/2024. Active resuscitation requires NRP-certified personnel and the full algorithm. Every birth needs at least ONE person whose only responsibility is the baby and who is competent at PPV.
What does this mean?
About 10 % of newborns need some help breathing at birth; ~1 % need active resuscitation. The NRP algorithm is a stepwise, time-bounded sequence that the WHO, AAP, AHA, and ILCOR maintain through 5-yearly consensus reviews. Core principles: (1) anticipate — antenatal risk factors (preterm, GDM, FGR, meconium, prolonged ROM) bring extra personnel; (2) warm, dry, stimulate — the first 30 seconds; (3) PPV is the single most important step — do it well, with chest rise and effective mask seal (MR SOPA mnemonic when it’s not working); (4) chest compressions only if HR < 60 despite 30 s of effective PPV; (5) delayed cord clamping ≥ 60 s for all vigorous newborns (WHO 2014, ACOG CO 814 2020) reduces anaemia, IVH, and improves long-term iron status. NRP’s eighth edition emphasises team communication, simulation training, and the rapid, evidence-based pivot to advanced steps when first-line interventions don’t work.
What is newborn resuscitation?
Steps to support newborn who needs help at birth. ~10% need some help; ~1% extensive. UK uses NLS (Newborn Life Support, ResusCouncil); US uses NRP.
First minutes sequence
- Vigorous baby: skin-to-skin with mum; routine care.
- Needs help: dry + stimulate + warm; cord clamping decisions.
- Assess at 30 sec.
- Breathing absent at 60 sec: PPV (mask + bag/T-piece) at 40-60 breaths/min.
- HR <100: ensure PPV effective.
- HR <60 after 30s PPV: chest compressions 3:1 ratio.
- No improvement: adrenaline + fluids.
Most babies respond within 1-2 minutes.
Why might baby need help?
- Preterm (lungs immature).
- Meconium aspiration.
- Birth asphyxia (cord prolapse, abruption, shoulder dystocia).
- Maternal opioids.
- Infections.
- Congenital anomalies.
- Multiple pregnancy.
- Maternal diabetes, severe PE.
Delayed cord clamping
Waiting 1-3 minutes (or until cord stops pulsing) before clamping. Benefits: ~30% more blood volume, better iron, less anaemia, better cardiovascular transition.
NICE / WHO / ResusCouncil recommend for vigorous babies including preterm.
Oxygen approach
- Start with air (21% O2) per current guidelines.
- Pulse oximeter guides.
- Target SpO2 by age: 60% at 1 min, 80-85% at 5 min, 85-95% at 10+ min.
- Preterm: may need oxygen at start (30-40%).
- Avoid hyperoxia — damages preterm lungs + retina.
Chest compressions
- HR <60/min after 30s effective PPV.
- 3:1 ratio (3 compressions, 1 breath).
- 90 compressions + 30 breaths per minute.
- 2-thumb encircling technique preferred.
- Depth 1/3 chest depth.
- Reassess HR every 60s.
Preterm-specific care
- Plastic bag/wrap + hat for warmth.
- Gentle handling.
- CPAP often preferred over routine intubation.
- Surfactant if RDS develops.
- Lower starting O2 (21-30%).
- Delayed cord clamping / cord milking.
- Specialist neonatal team present.
Can I be present?
Brief help: often at warmer near you. Major resuscitation: often moved to resus area but partner can sometimes stay. ResusCouncil UK increasingly supports parental presence.
If baby goes to NICU
- Express breast milk within 6 hours.
- Skin-to-skin (kangaroo care) when stable.
- Visit regularly; ask to be present at handovers.
- BLISS UK charity support.
- Photography services in many units.
Different scenarios
Scenario 1: Vigorous baby, brief drying + stimulation, APGAR 9/10
Skin-to-skin with mum. Delayed cord clamping. Standard care.
Scenario 2: Baby needs PPV for 1 minute, then breathing well
Brief support. Skin-to-skin once stable. Observation on postnatal ward.
Scenario 3: Preterm 30 weeks, CPAP from birth
NICU. Surfactant if RDS develops. Express breast milk. BLISS support.
Scenario 4: Severe HIE, chest compressions, adrenaline
NICU. Cooling for 72 hours if eligible (SARNAT 2-3). Specialist care + counselling.
Scenario 5: Meconium-stained liquor, baby vigorous at birth
No routine intubation (per current guidelines). Drying + monitoring. PPV only if needed.
Care guidance — newborn resuscitation
- Birth team trained + equipment ready.
- Anticipate in high-risk births.
- Air first; O2 titrated.
- Delayed cord clamping when possible.
- Skin-to-skin asap.
- Express milk if baby NICU.
- BLISS support for families.
- Follow-up developmental assessments.
Sources
- Resuscitation Council UK. Newborn Life Support (NLS) 2021.
- ILCOR. International Liaison Committee on Resuscitation Consensus.
- AAP / AHA. Neonatal Resuscitation Programme (NRP) 8th edition.
- BLISS UK. bliss.org.uk.
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Frequently asked questions
What is neonatal resuscitation?
STEPS to support newborn baby who needs help breathing / circulation at birth. ~10% of newborns need some help; ~1% need extensive resuscitation. INTERNATIONAL guidelines: NRP (Neonatal Resuscitation Programme, US) or NLS (Newborn Life Support, UK / Europe — Resuscitation Council UK). PROTOCOL has clear sequence: warm, dry, stimulate → assess breathing + heart rate → support breathing if needed → chest compressions if very low heart rate → medications rarely. PERFORMED by midwives, neonatologists, paediatricians, trained nurses.
What happens in the first minutes after birth?
(1) IMMEDIATE assessment — tone, breathing, colour, heart rate; (2) IF VIGOROUS: skin-to-skin with mum; routine care. (3) IF NEEDS HELP: dry + stimulate + warm; cord clamping decisions; assess at 30 sec. (4) BREATHING absent / inadequate at 60 sec: positive pressure ventilation (PPV) — mask + bag/T-piece. (5) HEART RATE <100: ensure PPV effective; <60 after 30 sec PPV: chest compressions. (6) NO IMPROVEMENT: adrenaline, fluids, advanced support. MOST babies respond to simple measures within 1-2 minutes.
Why might my baby need resuscitation?
(1) PRETERM (lungs immature); (2) MECONIUM aspiration; (3) BIRTH ASPHYXIA (cord prolapse, abruption, shoulder dystocia); (4) MATERNAL OPIOIDS (respiratory depression); (5) INFECTIONS; (6) CONGENITAL ANOMALIES (heart, lung, airway); (7) MULTIPLE PREGNANCY; (8) MATERNAL conditions (diabetes, severe PE); (9) RAPID DESCENT through birth canal; (10) UNEXPECTED — sometimes no clear cause. ANTICIPATION + preparation in high-risk births; team standing by for prompt action.
What's the APGAR score?
5-COMPONENT SCORE assessed at 1 + 5 MINUTES (and 10 min if low). APPEARANCE (colour), PULSE (heart rate), GRIMACE (reflexes), ACTIVITY (tone), RESPIRATION. EACH 0-2; TOTAL 0-10. 7-10: NORMAL; 4-6: MODERATELY DEPRESSED; 0-3: SEVERELY DEPRESSED. NOT a diagnosis — guides need for resuscitation + recovery. LOW APGAR doesn't predict long-term outcomes well; PROLONGED LOW (after 10 min) more concerning. /calculators/apgar-score for detail.
Will it harm my baby long-term?
DEPENDS on cause + duration of any oxygen deprivation. BRIEF resuscitation (under 2 min, response good): usually no lasting effects. PROLONGED (5+ min low APGAR, HIE features): may need cooling + follow-up. MOST babies who needed routine birth resuscitation grow up healthy. EARLIER + EFFECTIVE response reduces long-term injury. NRP / NLS save many babies' lives + outcomes annually.
What's delayed cord clamping?
WAITING 1-3 MINUTES (or until cord stops pulsing) before clamping cord. BENEFITS for baby: ~30% more blood volume (better iron stores, less anaemia); better cardiovascular transition; reduced need for transfusion in preterm. NICE / WHO / ResusCouncil UK now recommend DELAYED CLAMPING for vigorous babies including preterm. RECENT EVIDENCE: even longer (3-5 min) better for preterm. EXCEPTIONS: baby needs resuscitation immediately (sometimes 'milking' the cord done if no time for delay). Cord blood banking possible but should not delay clamping when delayed clamping recommended.
What's positive pressure ventilation (PPV)?
BREATHS DELIVERED via mask placed over baby's face. T-PIECE RESUSCITATOR (Neopuff) preferred in UK NHS — controlled pressure + inspiratory time. AMBU BAG alternative. AIR INITIALLY (room air, 21% O2) per NRP/NLS — adding oxygen if not improving. RATE: 40-60 BREATHS/MIN. EFFECTIVE PPV signs: HR rising, chest movement, oxygen saturation improving. ~80-90% of babies needing help respond to PPV alone.
Why might my baby need oxygen?
STARTING with AIR (21% O2) per current guidelines — higher O2 not always better. INCREASE if: (1) HR not rising despite PPV; (2) SpO2 below target (varies by age — 60% at 1 min, 80-85% at 5 min, 85-95% at 10+ min); (3) Persistent cyanosis. TITRATED to lowest needed. PRETERM may need oxygen at start (FiO2 30-40%). PULSE OXIMETER guides decisions. AVOID hyperoxia — too much oxygen damages preterm lungs + retina.
When are chest compressions needed?
HEART RATE <60/MIN AFTER 30 seconds of effective PPV. RATIO: 3 compressions to 1 breath (3:1). 90 COMPRESSIONS + 30 BREATHS PER MINUTE. TECHNIQUE: 2 thumbs on chest (preferred), encircling chest; depth 1/3 chest depth. ASSESS HR every 60 seconds. IF HR rises above 60: stop compressions, continue PPV; >100: stop PPV if breathing. RARE — most babies don't need.
What about adrenaline?
RARE — used if HR remains <60 after 30 sec compressions + effective PPV. UMBILICAL VEIN access preferred. DOSE: 0.01-0.03 mg/kg IV. Some give endotracheal first while access secured. REPEATED every 3-5 min if needed. FLUIDS (saline 10 mL/kg) if blood loss suspected. ADVANCED resuscitation pathway. <0.5% of newborn births need.
What about transition for preterm baby?
PRETERM resuscitation specific: (1) THERMAL CARE — plastic bag/wrap, hat, warm room (>26°C); (2) GENTLE handling; (3) CPAP (continuous positive airway pressure) often preferred over routine intubation; (4) SURFACTANT if RDS develops; (5) LOWER STARTING O2 (21-30%); (6) DELAYED cord clamping (1-3 min)/CORD milking; (7) UMBILICAL VENOUS CATHETER for access. SPECIALIST NEONATAL TEAM present. BLISS support for families.
Can I be present during resuscitation?
DEPENDS on situation. STANDARD birth with brief help: often happens at warmer near you. MAJOR resuscitation: usually moved to resus area but parent can sometimes stay. NICU transfer needed: brief look + photo possible before transfer. PARENTS RIGHTS to be present being increasingly recognised; ResusCouncil UK supports. BIRTH PARTNER often gives important emotional + practical support. STAFF will EXPLAIN as much as possible.
What if my baby went to NICU?
SEPARATION distressing. EXPRESS BREAST MILK from the start (within 6 hours ideally) — hospital pump. SKIN-TO-SKIN ('kangaroo care') when stable — protective for baby + bonds. VISIT regularly. ASK questions; ask to be present at handovers. BLISS UK charity provides emotional + practical support. NICU TOUR helps. PHOTOGRAPHY service in many units. RECOVERY can be gradual; updates daily.
What's the long-term outlook?
DEPENDS on severity + cause. MOST babies who needed routine resuscitation develop normally. BABIES with HIE (cooled): variable; ~50-60% normal outcomes. PRETERM <28 weeks: more variable; specialist follow-up. ANNUAL DEVELOPMENTAL assessments to age 2-3. PHYSIO / OT / SALT if delays. EARLY INTERVENTION improves outcomes. MAJORITY thrive with appropriate care + family love.
How does this relate to other calculators on BumpBites?
Companion: /calculators/apgar-score; /calculators/sarnat-hie; /calculators/neonatal-cooling; /calculators/silverman-andersen; /calculators/eos-sepsis; /calculators/new-ballard; /calculators/antenatal-steroids; /calculators/magnesium-sulphate.