Most newborns breathe on their own, but about 1 in 10 needs help to start breathing and a few need full resuscitation. Effective ventilation of the lungs is the most important step, because newborn arrest is almost always caused by lack of oxygen.
Key symptoms
- Not breathing or only gasping after birth
- Poor muscle tone, limp body
- Heart rate below 100 per minute
- Blue or pale color that does not improve
- Preterm birth or meconium-stained fluid
What you find on exam
- Three quick questions: term? good tone? breathing or crying?
- Heart rate by stethoscope at the chest or by ECG
- Breathing effort and chest rise with ventilation
- Pulse oximetry on the right hand
- Temperature, aiming for 36.5 to 37.5 °C
Tests
- Apgar at 1 and 5 minutes; it does not decide when to start resuscitation
- Pre-ductal oxygen saturation targets by minute of life
- Glucose after resuscitation
- Cord blood gas if available
Treatment basics
- Warm, dry, stimulate and position the airway; suction only if obstructed
- Apnea or heart rate under 100: positive pressure ventilation at 40 to 60 breaths per minute within the first minute
- Fix ventilation with the MR SOPA steps if the chest does not rise
- Heart rate under 60 after 30 seconds of good ventilation: compressions at a 3 to 1 ratio with 100 percent oxygen
- Epinephrine IV or IO if the heart rate stays under 60
Red flags
- Heart rate under 60 per minute
- No chest rise with ventilation
- Low temperature or low blood sugar after resuscitation
Practice it in Making Synapses
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; AHA Guidelines for CPR and ECC; NCSBN 2026 NCLEX-RN Test Plan. Written by Making Synapses. Making Synapses is not affiliated with these organizations.