Birth - Initial Assessment
Newborn delivered - rapid evaluation needed
All Pathways
PediatricsEmergency
Neonatal Resuscitation (NRP 2025)
Neonatal Resuscitation (NRP 2025): Birth - Initial Assessment → Initial Questions → Routine Care.
Pathway Overview
13 steps
Algorithm Steps
13 total
01Start 02Decision Initial Questions
Assess newborn transition
- Term gestation?
- Good tone?
- Breathing or crying?
03Outcome Routine Care
Newborn is transitioning normally
- Provide warmth (skin-to-skin with parent)
- Clear airway if needed (suction mouth then nose)
- Dry and ongoing evaluation
- Delayed cord clamping (≥60 seconds)
04Action Initial Stabilization Steps
Perform within 30 seconds
- Warm: Radiant warmer, plastic wrap if preterm <32 wks
- Position: Head in neutral/sniffing position
- Clear airway: Suction if secretions obstructing
- Dry: Stimulate by drying (term infants)
- Consider delayed cord clamping if feasible
05Decision Assess Breathing & HR
Evaluate after initial steps
- Is baby breathing/crying?
- Heart rate >100 bpm? (assess by auscultation or pulse oximetry)
- Path rejoins step 03Shared downstream outcome
06Action Positive Pressure Ventilation (PPV)
Apnea, gasping, or HR <100 - start PPV
- Rate: 40-60 breaths/min
- Pressure: Start 20-25 cm H2O (term)
- Use room air initially for term (21% O2)
- Use 21-30% O2 for preterm <35 weeks
- Assess chest rise - adjust as needed
- Apply pulse oximeter to right hand
07Warning MR SOPA - Ventilation Corrective Steps
If chest not rising, correct technique
- M - Mask adjustment (ensure seal)
- R - Reposition airway (neutral position)
- S - Suction mouth then nose
- O - Open mouth slightly
- P - Pressure increase (up to 40 cm H2O)
- A - Alternative airway (ETT or LMA)
08Decision HR <60 after 30 sec PPV?
Reassess HR after adequate ventilation
- Ensure effective ventilation (MR SOPA)
- Consider intubation
- If HR remains <60 despite effective ventilation...
09Outcome Post-Resuscitation Care
Monitor and stabilize
- Continue monitoring HR, SpO2
- Maintain normothermia
- Check glucose
- Consider therapeutic hypothermia if moderate/severe HIE
- Transfer to NICU
10Action Chest Compressions + PPV
HR <60 despite effective ventilation
- Intubate if not already done
- Increase O2 to 100%
- Two-thumb technique (preferred)
- Compress lower 1/3 of sternum
- Depth: 1/3 AP diameter of chest
- Ratio: 3 compressions : 1 breath (90:30/min)
- Coordinate with ventilation
11Decision HR <60 after 60 sec CPR?
Reassess after 60 seconds of coordinated CPR
- Path rejoins step 09Shared downstream outcome
12Action Epinephrine Administration
HR <60 despite PPV and compressions
- IV/IO route (preferred): 0.01-0.03 mg/kg (1:10,000)
- UVC is preferred IV access
- ETT route (if no IV): 0.05-0.1 mg/kg (1:10,000)
- May repeat every 3-5 minutes
- Consider volume expansion if hypovolemia suspected
13Action Volume Expansion
If blood loss or hypovolemia suspected
- Normal saline or O-negative blood
- 10 mL/kg IV over 5-10 minutes
- May repeat if needed
- Path rejoins step 09Shared downstream outcome
- Path rejoins step 09Shared downstream outcome
- Path rejoins step 08Shared downstream outcome
Guideline Source
2025 AHA/AAP Guidelines - Part 5: Neonatal Resuscitation
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Applies to term and preterm newborns in delivery room
- Does not cover congenital anomalies management
- Does not address prolonged NICU resuscitation
- Assumes trained resuscitation team available
Applicable Regions
USEU
Version 1Next review: 2027-01-11
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Related Resources
Frequently Asked Questions
What is the Neonatal Resuscitation (NRP 2025)?
The Neonatal Resuscitation (NRP 2025) is a emergency clinical algorithm for Pediatrics. It provides a structured decision tree to guide clinical decision-making, based on 2025 AHA/AAP Guidelines - Part 5: Neonatal Resuscitation.
What guideline is the Neonatal Resuscitation (NRP 2025) based on?
This algorithm is based on 2025 AHA/AAP Guidelines - Part 5: Neonatal Resuscitation (DOI: 10.1161/CIR.0000000000001367).
What are the limitations of the Neonatal Resuscitation (NRP 2025)?
Known limitations include: Applies to term and preterm newborns in delivery room; Does not cover congenital anomalies management; Does not address prolonged NICU resuscitation; Assumes trained resuscitation team available. Individual patient factors may require deviation from these recommendations.
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