Synopsis
Prepare safely for birth, support normal transition, prioritise effective lung inflation when a newborn is compromised, escalate through ventilation, compressions and drugs in the 2025 UK sequence, and provide temperature, glucose, family and post-resuscitation care.
- Before birth brief the team, allocate roles, check warmer, gas supply, blender, suction, ventilation interfaces, oximeter, ECG, airway equipment, emergency access and drugs.
- Aim for cord clamping after at least 60 seconds while warming, stimulating and assessing when safe; never delay necessary resuscitation that cannot be delivered with the cord intact.
- Maintain 36.5–37.5°C. At less than 32 weeks, place the body in a polyethylene wrap without drying, dry and cover the head and use a preheated radiant warmer.
Key red flags
Absent or ineffective breathing, gasping, marked hypotonia or heart rate below 100/min requires immediate respiratory support rather than prolonged stimulation.
Investigation priorities
Determine whether transition is adequate and measure the response to every ventilation or compression cycle.
Management branches
Birth is imminent or neonatal compromise is anticipated.
- Review gestation, fetal condition, maternal history and agreed extent of care and summon an appropriately skilled team.
- Allocate leadership, airway, monitoring, access, documentation and family support and check every item before birth.
Key medicines
Adrenaline 1:10,000, 0.1 mg/mLIf heart rate remains below 60/min after effective ventilation and 30 seconds of compressions, give 20 micrograms/kg, equivalent to 0.2 mL/kg, by umbilical venous or intraosseous route; repeat every 4 minutes while indicated. If intubated without vascular access, give 100 micrograms/kg, 1 mL/kg, intratracheally as a bridge.
Glucose 10%Check blood glucose during prolonged resuscitation where possible. If it is low, give 200 mg/kg, equivalent to 2 mL/kg of 10% glucose, intravenously or intraosseously, then provide gestation-appropriate infusion and repeat measurement under the neonatal protocol.