Initial Steps (Golden 60 Seconds)
- Position and clear airway (sniffing position)
- Dry and stimulate (tactile stimulation)
- Evaluate breathing and HR
- If apneic/bradycardic: start PPV within 60 seconds
APGAR Score
Appearance, Pulse, Grimace, Activity, Respiration — scored at 1 and 5 minutes.
Positive Pressure Ventilation
Rate: 40-60 breaths/min. Pressure: 20-25 cm H2O. Check chest rise.
Chest Compressions
Indicated when HR <60 despite 30 seconds of effective PPV. Ratio: 3:1 (90 compressions + 30 breaths/min).
Medications
Epinephrine (0.01-0.03 mg/kg) via ET tube or IV. Volume expanders (normal saline) for hypovolemia. Naloxone for opioid-induced depression.
References & further reading
Every clinical claim in this article is anchored to a primary source. Click through to verify, and use the same habit in your revision.
Revision history
- 19 September 2026 — Initial publication
Frequently asked questions
What is the initial step in neonatal resuscitation?
Provide warmth, clear airway if needed, dry and stimulate the baby. 90% of newborns breathe spontaneously after drying and stimulation.
When should PPV be started?
PPV (positive pressure ventilation) is indicated if the baby is apneic after initial steps, has heart rate <100 bpm, or has persistent central cyanosis despite free-flow oxygen.
What is the ventilation rate for neonatal PPV?
40-60 breaths per minute. Use a pressure of 20-25 cm H2O. Reassess heart rate and color after 30 seconds of effective PPV.
Related reading
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