Newborn resuscitation (2025 AHA/AAP)
A clock from birth with the preductal SpO₂ target for the current minute, a heart-rate decision helper that tracks the 30-second ventilation and 60-second compression checks, weight-based epinephrine and volume doses, an IV/IO epinephrine timer, and a one-tap event log you can copy.
Not a substitute for certified AHA/AAP neonatal resuscitation training. Independent summary in our own words; not an AHA or AAP product.
1Record an event
Start the clock at birth to enable one-tap logging.
Chest moving, corrective step, compressions and epinephrine are in the heart-rate panel. Laryngeal mask, intubation and corrective steps restart the 30 s count: tap “Chest moving” again once the chest rises.
2Event log
Tap the log to copy it as plain text.
3Gestational age
4Epinephrine and volume
Kilograms, not grams. Plausible newborn range 0.3–6 kg. No weight estimate is offered.
- When (§15, Class 1, B-NR): HR has not reached 60/min after optimizing ventilation (100% oxygen, preferably through an alternative airway) and compressions. Intravascular 0.01–0.03 mg/kg.
- Access (§14): umbilical venous catheter (Class 1, C-LD); intraosseous if IV access fails or isn't feasible (Class 2a, C-LD). IO devices can cause fractures, extravasation with compartment syndrome, and tissue necrosis.
- Endotracheal (§15, Class 2a, C-LD): a larger dose, 0.05–0.1 mg/kg, while vascular access is being obtained. No adequate response to an ET dose: give intravascular epinephrine as soon as access is obtained, regardless of the dosing interval (Class 2a, B-NR).
- Repeat (§15, Class 2b, C-LD): every 3–5 min, preferably intravascularly, if HR stays below 60/min. Repeated ET doses or higher IV doses can cause harmful plasma levels.
- Volume (§16, Class 2b, C-EO): only with evidence of hypovolemia (history and exam) and HR still below 60/min despite ventilation, compressions and epinephrine. Normal saline or blood 10–20 mL/kg, as a steady infusion over 5–10 min; repeat if the response is inadequate. For major blood loss, O Rh-negative blood without waiting for a crossmatch, or crossmatched blood if it's already on hand. Consider tension pneumothorax too.
Reference (2025 AHA/AAP)
SpO₂ targets and starting oxygen
| After birth | Preductal SpO₂ |
|---|---|
| 2 min | 65–70% |
| 3 min | 70–75% |
| 4 min | 75–80% |
| 5 min | 80–85% |
| 10 min | 85–95% |
The 2025 table starts at 2 minutes; a 1-minute reading won't routinely be available. Between 5 and 10 minutes the tool shows the 5-minute row and the 10-minute goal; it does not interpolate. Probe on the right hand or wrist. Place the oximeter as soon as possible on any newborn receiving respiratory support (Class 1).
Starting oxygen (Class 2b): 35 weeks or more 21%; 32+0–34+6 weeks 21–30%; under 32 weeks 30–100%. Titrate to the targets (Class 1). During compressions, 100% may be reasonable (Class 2b).
Ventilation
Start within 60 s of birth if gasping or apneic, or if HR stays below 100/min despite initial steps (Class 1). Peak inflation pressure 20–30 cm H₂O to start, then adjust (Class 2a); avoid excessive pressure (Class 3: Harm). PEEP may be reasonable (Class 2b). Rate 30–60/min (Class 2a). Inflation time 0.5–1 s (Class 2a). No routine sustained inflations over 5 s under 28 weeks (Class 3: Harm). T-piece can be better than a self-inflating bag (Class 2a).
Corrective steps when HR doesn't rise (Class 2a): reposition the airway, adjust the mask or use a 2-hand hold, suction, raise the pressure, alternative airway. Video laryngoscopy can help intubation (Class 2a). Laryngeal mask recommendations apply at 34+0 weeks or more: as rescue when face-mask ventilation fails (Class 2a) or as the first interface (Class 2b).
CPAP: for spontaneously breathing preterm infants who need support, CPAP rather than intubation is reasonable (Class 2a). At 34 weeks or more, its usefulness for infants with or at risk of respiratory distress is not well established (Class 2b).
Compressions
Start when HR stays below 60/min despite 30 s of ventilation (Class 1). The guideline's summary describes that ventilation as moving the chest, preferably through an alternative airway (endotracheal tube or laryngeal mask). Ventilate through an endotracheal tube during compressions (Class 1); laryngeal mask at 34 weeks or more if a tube isn't possible (Class 2b). 3:1, about 90 compressions and 30 inflations per minute; two-thumb encircling hands; lower third of the sternum; one third of the chest depth; change compressor every 2–5 min (all Class 2b). Use ECG for heart rate during compressions (Class 1).
Cord and temperature
Defer clamping at least 60 s if no immediate resuscitation is needed: term Class 2a, preterm Class 1. Intact cord milking: may be reasonable for nonvigorous infants at 35 weeks or more (Class 2b), and at 28+0–36+6 weeks when deferred clamping can't be done (Class 2b). Do not milk under 28+0 weeks (Class 3: Harm).
Keep 36.5–37.5 °C through admission and stabilization; prevent temperatures below 36 °C and above 38 °C (Class 1). Preterm: radiant warmer, plastic wrap with a cap, warmer room, warmed humidified inspired gases (Class 2a). No routine suctioning, clear or meconium-stained fluid (Class 3: No Benefit).
After resuscitation and stopping
Monitor breathing effort and oxygenation, heart rate, temperature and blood glucose. Transitional problems include respiratory compromise, hypoglycemia and hypothermia. Talk with the family and debrief the team.
Therapeutic hypothermia (§17, Class 1, A): offer it under clearly defined protocols to infants over 36 weeks with moderate-to-severe HIE: 33.5–34.5 °C, started within 6 h of birth, for 72 h. Under 36 weeks it has not shown benefit and may cause harm. Glucose (Class 1, B-NR): after prolonged ventilation or advanced resuscitation, check early and keep checking until it holds in the normal range. Rewarming (Class 1, C-LD): rewarm if unintentionally below 36 °C; the best rate is unknown.
Stopping (§18): with no heart rate after every step, talk with the team and the family about stopping; about 20 minutes after birth is the suggested point (Class 1, C-LD). Not starting and stopping life-sustaining treatment are ethically equivalent (Class 1, C-EO). The tool flags 20:00 only while “No HR” is selected; it never tells you to stop.
What this tool leaves out, and why
Drug volumes in mL: Part 5 names no epinephrine concentration, so only mg is shown. Weight estimates: none, because Part 5 gives no rule. Enter a measured or best-known weight.
The timers use the device clock (differences between timestamps), so they stay correct if the screen locks or the tab is in the background. Nothing is stored or sent; closing or reloading the page clears the log, so copy it first.
Sources
- Lee HC, Strand ML, Finan E, et al. Part 5: Neonatal Resuscitation: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2025;152(16 Suppl 2):S385–S423. doi:10.1161/CIR.0000000000001367. Co-published in Pediatrics 2026;157(1):e2025074352. Online text: cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/neonatal-resuscitation (§8–13; §14 vascular access, §15 epinephrine, §16 volume expansion, §17 postresuscitation care, §18 withholding and discontinuing).
- American Heart Association, American Academy of Pediatrics. 2025 Neonatal Resuscitation Algorithm (cpr.heart.org). Source of the SpO₂ target table, UVC or IO epinephrine every 3–5 minutes, and the hypovolemia and pneumothorax prompts.
- American Heart Association. Highlights of the 2025 AHA Guidelines for CPR and ECC (cpr.heart.org). Which neonatal recommendations are new or updated.
Educational reference only — not a substitute for clinical judgment, institutional protocols, or specialist advice. Calculations run in your browser; nothing you enter is sent or stored.