Honoured to Serve on the Neonatal Task Force for the 2025 Guidelines and be part of the ILCOR MEETING Rotterdam 2025

am honoured to be part of the Neonatal Task Force within ILCOR, representing the Heart & Stroke Foundation of Canada. Our Task Force met in Rotterdam in October to celebrate the launch of the 2025 guidelines and to continue the work shaping the 2026 and beyond neonatal resuscitation recommendations.

These updates reflect global collaboration, rigorous evidence review, and our collective commitment to improving outcomes for newborns worldwide. Below is a concise overview of the core changes highlighted in the 2025 CoSTR.

Highlights from the 2025 Neonatal CoSTR

1. Team Preparation & Communication

Resuscitation effectiveness starts before birth. The CoSTR reinforces structured team briefings, clear role assignment, and proactive communication with obstetric and midwifery colleagues. While outcome data are still limited, this approach reliably improves readiness and team performance.

2. Umbilical Cord Management

The update introduces standardized definitions:

• ICC: ≤15 sec

• ECC: <60 sec

• DCC: ≥60 sec

• PBCC: clamp based on physiology, not time

• I-UCM vs C-UCM defined as separate procedures

Key practice points:

• For non-vigorous term/late preterm infants, intact cord milking may reduce moderate–severe HIE and improve hemoglobin.

• For preterm <37 weeks, DCC ≥60 seconds remains standard.

• UCM is not recommended <28 weeks.

  
  

3. Temperature Management

Normothermia is essential.

• Term/late preterm: room temp ≥23 °C, skin-to-skin encouraged.

• Preterm: plastic wrap, heated mattresses, hats, and warmed/humidified gases.Avoid both hypothermia and hyperthermia through continuous monitoring.

  
  

4. Airway & Ventilation

• T-Piece resuscitator remains preferred for PPV.

• Laryngeal mask airway is an effective backup when mask ventilation fails or intubation is not feasible.

• Routine suctioning, even with meconium, is discouraged unless obstruction is visible.

  
  

5. Medications & Vascular Access

• Sodium bicarbonate is not recommended; emerging evidence suggests potential harm when combined with vasoconstrictors.

• Umbilical venous catheter remains first line; intraosseous access is acceptable if umbilical access cannot be achieved.

  
  

6. Volume Expansion

Only provide fluids when blood loss is suspected or when the infant is unresponsive to ventilation, compressions, and medications. Routine boluses are not supported.

7. Glucose Monitoring & Post-Resuscitation Care

• Both hypo- and hyperglycemia can worsen outcomes.

• Start early glucose checks and repeat frequently, especially in high-risk infants (preterm, those receiving compressions/epinephrine, or with HIE).

• Rewarm hypothermic infants with a structured protocol; no evidence favors fast vs slow rewarming.

• Therapeutic hypothermia remains standard for term infants with moderate–severe HIE in NICU-capable centers.

  
  

8. Prognostication & Family Presence

After 20 minutes of effective resuscitation without ROSC, survival with good neurodevelopment becomes unlikely, but decisions must remain individualized.Family presence during resuscitation is increasingly supported when feasible, promoting transparency and compassionate care.

Looking Ahead

The 2025 CoSTR continues the shift toward individualized, physiology-guided resuscitation, optimization of cord management, refinement of ventilation strategies, and structured team-based care. Evidence gaps remain — and they define the research agenda for the next decade. I am grateful for the opportunity to contribute to this work with exceptional colleagues from around the world.