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The vast majority of newborn infants have a successful transition from intrauterine to extrauterine life without need of assistance; however, approximately 10% require some degree of resuscitative support in the delivery room.1 The presence of certain antepartum, intrapartum, or postpartum risk factors predicts many but certainly not all infants who require help in the delivery room (Table 42-1). Premature, when compared to term infants, are at particular risk for having difficulty with transition following birth. The most common contributing factor for infants in need of resuscitation is asphyxia. Asphyxia is a lack of gas exchange; it results in concomitant hypoxia and hypercapnia and causes a mixed metabolic and respiratory acidosis. The asphyxia can result from either failure of placental gas exchange before birth or deficient pulmonary gas exchange once the newborn is delivered.

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Table 42-1. Antepartum, Intrapartum, and Postpartum Factors Associated with Need for Newborn Resuscitation

Prompt, effective reversal of asphyxia (with a major focus on effective ventilation) can potentially prevent and certainly minimize multiorgan failure, death, and disability. Nearly 1 million newborns worldwide die from birth asphyxia.1 As a result, development of competence in effective newborn resuscitation has the potential to make a profound global impact on the health of children.


Anticipation and planning for both expected and unexpected neonatal emergencies is essential for success. If a fetus is at high risk for needing resuscitation in the delivery room, antepartum triage to a center with expertise in high-risk stabilization should be attempted if it is safe to do so. Regardless, every birth should have at least 1 person immediately available to focus solely on the newborn to assess the need for and, when required, initiate ...

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