Initial Steps in Neonatal Resuscitation Protocol

Assessment and Initial Stabilization

The American Heart Association recommends that the initial step in neonatal resuscitation is to provide warmth, position the head in a "sniffing" position to open the airway, clear secretions only if copious and/or obstructing the airway, dry the infant, and stimulate breathing, as stated by the American Academy of Pediatrics 1, 2, 3
The American Academy of Pediatrics suggests assessing the infant's term gestation, tone, and breathing or crying status before initiating resuscitation, with the goal of determining the need for intervention 1, 2
If the infant is term, has good tone, and is breathing or crying, they may stay with the mother for routine care, including drying, skin-to-skin contact, and covering with dry linen to maintain normal temperature, as recommended by the American Heart Association 2, 3

The American Academy of Pediatrics recommends providing warmth by placing the baby under a radiant heat source, positioning the head in a "sniffing" position to open the airway, clearing the airway if necessary, drying the baby thoroughly, and providing tactile stimulation to initiate breathing, as part of the initial stabilization steps 2, 3, 4, 5, 6

The American Heart Association suggests that the neonatal resuscitation protocol follows a sequence of initial steps, ventilation and oxygenation, chest compressions, and administration of epinephrine and/or volume expansion, with the goal of optimizing outcomes for newborns requiring assistance at birth 2, 3
The "Golden Minute" is a critical period of approximately 60 seconds for completing the initial steps, reevaluating, and beginning ventilation if required, as emphasized by the American Academy of Pediatrics 1, 2

The American Academy of Pediatrics recommends simultaneous evaluation of heart rate, respirations, and oxygen saturation via pulse oximetry during resuscitation, with the goal of monitoring the infant's response to intervention 2, 3

The American Academy of Pediatrics suggests that preterm infants require additional warming techniques, including prewarming the delivery room, covering the baby in plastic wrapping, placing the baby on an exothermic mattress, and placing the baby under radiant heat, to prevent hypothermia and optimize outcomes 6
The American Heart Association recommends maintaining temperature between 36.5°C and 37.5°C to prevent hypothermia and associated morbidities, especially in preterm infants 7, 6