2025 American Heart Association (AHA) & American Academy of Pediatrics (AAP) Neonatal Resuscitation Guidelines

The 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (Part 5: Neonatal Resuscitation) mark a major evolution in newborn care. These updates emphasize prevention, preparation, teamwork, and recovery — recognizing that every stage from pregnancy to postnatal follow-up influences survival and long-term outcomes.

🔗 The “Newborn Chain of Care”

A new framework called the Newborn Chain of Care highlights seven interconnected steps to optimize neonatal outcomes:

1. Prevention – Healthy pregnancies through early risk assessment, nutrition, psychosocial support, and management of maternal conditions.

2. Recognition & Activation – Identifying infants at risk and mobilizing trained teams before delivery.

3. Initial Steps – Temperature control, drying, stimulation, and deferred cord clamping for ≥60 seconds while supporting skin-to-skin contact.

4. Ventilation – The cornerstone of neonatal resuscitation; effectiveness is judged by a rising heart rate.

5. Advanced Resuscitation – Initiate chest compressions if heart rate <60 bpm despite ventilation; give epinephrine (preferably UVC/IO) and consider volume expansion if blood loss is suspected.

6. Postnatal Care – Ongoing monitoring of temperature, oxygenation, and glucose stability after stabilization.

7. Recovery & Follow-Up – Coordinated care between hospital and community teams to support families and neurodevelopment.

❤️ Top 10 Take-Home Messages for Neonatal Life Support

1. Resuscitation begins before birth – Good prenatal and perinatal care reduce risk.

2. Team readiness matters – Anticipation and training improve outcomes.

3. Most newborns don’t need resuscitation – Observe during deferred cord clamping and skin-to-skin.

4. Effective ventilation is key – A rising heart rate signals success.

5. Alternative airways (laryngeal mask or ETT) if mask ventilation fails.

6. Temperature monitoring prevents both hypothermia and hyperthermia.

7. Pulse oximetry guides oxygen titration within target ranges.

8. Chest compressions for HR <60 bpm after corrective ventilation steps.

9. Epinephrine via intravascular route if HR remains <60 bpm after compressions.

10. Discuss redirection of care when no heart rate is detected after 20 minutes of effective resuscitation.

🌬️ Updated Clinical Highlights

• Oxygen Supplementation

  • Term & late preterm: 21% (air)

  • 32–35 weeks: 21–30%

  • <32 weeks: 30–100% to reach target SpO₂ by pulse oximetry

• Ventilation & CPAP

  • Primary intervention for apnea or bradycardia.

  • For spontaneously breathing preterm infants, CPAP supports lung aeration.

  • Laryngeal Mask as an alternative to face mask

• Chest Compressions

  • 3:1 compression-to-ventilation ratio (≈90 compressions + 30 inflations/min).

  • Two-thumb encircling hands technique recommended.

• Vascular Access & Epinephrine

  • Umbilical venous access preferred; intraosseous route acceptable.

  • Endotracheal epinephrine only while vascular access is being obtained.

👩‍⚕️ Training and Systems of Care

Every birth should be attended by at least one trained provider whose sole responsibility is newborn care.Checklists, team briefings, and regular simulation training improve readiness, reduce errors, and increase compliance with evidence-based practices.

🌍 Addressing Disparities

Despite major progress, neonatal mortality and morbidity remain unevenly distributed. The guidelines stress reducing systemic inequities—particularly among Black, Indigenous, and Pacific Islander populations—through better access to quality perinatal and neonatal care.

🧠 Key Message

Effective neonatal resuscitation isn’t just about emergency response—it’s about a continuum of care that begins before birth and continues through family follow-up. The 2025 guidelines set a vision where prevention, precision, and partnership drive every step of newborn care.

Citation:Lee HC, Strand ML, Finan E, Illuzzi J, Kamath-Rayne BD, Kapadia VS, Niermeyer S, Schmölzer GM, et al. Part 5: Neonatal Resuscitation: 2025 AHA/AAP Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(Suppl 2):S1–S12. DOI: 10.1161/CIR.0000000000001367.