Neonatal resuscitation from the nursing side: preparing, the golden minute and assisting
- Procedure
Most newborns breathe alone. For the few who do not, the team must have everything ready and start ventilation within the first minute.
What it is
About 1 in 10 newborns needs some help to start breathing, and fewer than 1 in 100 needs advanced resuscitation. The first 60 seconds, the golden minute, are for warming, drying, positioning, stimulating and, if the baby still does not breathe well, starting ventilation with a mask. Heart rate is the best sign that resuscitation is working. The nurse prepares the place and the equipment before every birth, takes the roles the team leader gives (warmth, oximeter, timing, record), and cares for the baby after the event. This page shows the nursing role; the team follows the current neonatal resuscitation guideline.
Indications
- A baby who does not breathe or cry, or has poor tone, after birth.
- A heart rate below 100 per minute or gasping after the first steps.
- Anticipate it: preterm birth, signs of fetal distress, growth restriction, meconium-stained fluid, drugs given to the mother before birth.
Contraindications and precautions
- Do not suction routinely: only if the airway is blocked, briefly. Do not suction routinely through meconium-stained fluid.
- Never delay resuscitation to wait for cord clamping.
- Do not give extra oxygen by default: oxygen in excess harms; titrate it to the saturation target for each minute.
- Avoid both cold and overheating; record the temperature.
- At every birth there must be at least one trained person whose main task is the newborn.
Equipment
- A radiant warmer switched on, warm towels and a cap; a plastic bag for very preterm babies.
- A self-inflating bag or other device with masks of several sizes, checked.
- Suction equipment, an oxygen supply with a blender, and a pulse oximeter with a neonatal sensor.
- A stethoscope, a clock and the record form.
- Equipment for the advanced team (airway devices, umbilical line and medicines) as the institutional protocol lists.
Step by step (and why)
- Before every birth, read the risks and check the warmer, the bag and masks, suction, oxygen and oximeter — resuscitation is never improvised.
- Brief the team and agree the roles — clear roles save seconds.
- At birth, answer the three questions; if all are yes, leave the baby with the mother — a vigorous baby does not need separating.
- If not, place the baby under the warmer, dry, keep the neck neutral and stimulate — these first steps start breathing in most babies.
- Listen to the heart rate and start the clock — heart rate guides each next step.
- If there is apnoea, gasping or a heart rate below 100, help start mask ventilation and watch the chest rise — effective breaths are the priority.
- Fix the oximeter sensor on the right hand and call out heart rate and saturation — they show the response and guide oxygen.
- If the heart rate stays below 60 after effective ventilation, help with compressions as the leader directs — they move blood while the heart recovers.
- Prepare medicines and lines only as the leader orders, per protocol — avoids errors in the rush.
- Record times, steps and the Apgar at 1 and 5 minutes, and keep the parents informed — the record guides later care.
Complications
- Cold or overheating during or after resuscitation.
- Low or high blood glucose after resuscitation.
- Slow heart rate or apnoea from deep or repeated suctioning.
- Harm from too much oxygen.
- Brain injury after asphyxia (hypoxic–ischaemic encephalopathy).
Next step: when to call for help
- Apgar below 7 at 5 minutes: the team rules out perinatal asphyxia and decides on transfer to a higher level.
- After resuscitation: monitor temperature, blood glucose, breathing, heart rate and saturation closely.
- Signs of encephalopathy: tell the doctor at once. Therapeutic cooling works best when started within 6 hours; do not warm the baby unless the team says so.
- Transfer the baby, when needed, with safe neonatal transport suited to its condition.
Test yourself
Think of the answer, then tap the question to see it.
Which three questions decide, at birth, whether a newborn needs help?
Is it term? Is it breathing or crying? Does it have good muscle tone? If all are yes, it stays with its mother for routine care.
Which sign best shows that resuscitation is working?
A rising heart rate.
When do chest compressions start in neonatal resuscitation?
When the heart rate stays below 60 per minute after at least 30 seconds of effective ventilation.
Why is the oximeter sensor placed on the right hand?
It gives the preductal saturation, which guides how much oxygen the baby needs.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Singapore Neonatal Resuscitation Guidelines 2021 (Singapore Medical Journal, 62(8):404–414) (Singapore Resuscitation and First Aid Council, via PubMed Central, 2021); Salud sexual y reproductiva: guías para el continuo de atención de la mujer y el recién nacido focalizadas en APS, 3.ª ed. (CLAP/SMR 1577) (Organización Panamericana de la Salud, CLAP/SMR, 2011); Resolución 3280 de 2018: lineamientos técnicos y operativos de la Ruta de Promoción y Mantenimiento de la Salud y de la Ruta Materno Perinatal (Ministerio de Salud y Protección Social de Colombia, 2018); Guía de práctica clínica del recién nacido con asfixia perinatal: guía para familias y personas cuidadoras (Guía No. 07, actualización) (Ministerio de Salud y Protección Social de Colombia, IETS, 2026).
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Representative model, for educational purposes only.