Ten steps to improve outcomes of in-facility neonatal resuscitation

Elizabeth E Foglia¹, Siren Rettedal², Vinay Nadkarni³, Jackie K Patterson⁴, Peter G Davis⁵, Susan Niermeyer⁶, Asmita Acharya⁷, Santorino Data⁸, Maria Fernanda de Almeida⁹, Abiy Seifu Estifanos¹⁰, Jorge Fabres¹¹, Qi Feng¹², Ruth Guinsburg⁹, Kenechukwu Iloh¹³, Juin Yee Kong¹⁴, Estomih Mduma¹⁵, Mackenzie O'Reilly¹⁶, Viraraghavan Vadakkencherry Ramaswamy¹⁷, Suman Rao Pn¹⁸, Mario Rüdiger¹⁹, Sprina Joseph Ryoba²⁰, Jose Maria Solano²¹, Krothapalli Susila²², Marta Thio-Lluch⁵, Daniele Trevisanuto²³, Sithembiso C Velaphi²⁴, Gary M Weiner²⁵, Hege L Ersdal²

Affiliations

¹ University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA; Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA. Electronic address: foglia@chop.edu.
² Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway; University of Stavanger, Kjell Arholms Gate 41, 4021 Stavanger, Norway.
³ University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA; Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
⁴ University of North Carolina School of Medicine, 101 Manning Dr, Chapel Hill, NC 27599, USA.
⁵ The Royal Women's Hospital, University of Melbourne, 20 Flemington Rd, Parkville, VIC 3050, Australia.
⁶ University of Colorado School of Medicine, 13121 E 17th Pl, Aurora, CO 80045, USA.
⁷ Laerdal Global Health, Tanke Svilandsgate 30, P.O. Box 377, N-4002 Stavanger, Norway.
⁸ Mbarara University of Science & Technology, P. O Box 1410, Mbarara, Uganda.
⁹ Escola Paulista de Medicina, Universidade Federal de Sao Paulo, R. Botucatu, 740 - Vila Clementino, São Paulo, SP 04023-062, Brazil.
¹⁰ Center for Implementation Sciences (CIS), Addis Ababa University, NBH1, 4killo King George VI StAddis Ketema Sub-city, Addis Ababa, Ethiopia.
¹¹ Department of Neonatology, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago 8330077, Chile.
¹² Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing 100034, China.
¹³ University of Nigeria, Obukpa Rd, Nsukka 410105 Enugu, Nigeria.
¹⁴ KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore 229899 Singapore.
¹⁵ Haydom Lutheran Hospital, R24G+F74, Haydom, Tanzania.
¹⁶ Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
¹⁷ Ankura Hospital for Women and Children, Opposite NH65, Bagh Ameer, Sumitra Nagar Colony, Kukatpally, Hyderabad, Telangana 500072, India.
¹⁸ St. John's Medical College Hospital, Bangalore 560034, India.
¹⁹ Saxonian Center for Feto/Neonatal Health, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
²⁰ Government Hospital Dodoma, RP9V+3Q2, Hospital Rd, Dodoma, Tanzania.
²¹ Hospital Militar Central-Tv, 3C, 49-02 Bogotá D.C/Clínica de Marly Cl.50 # 9-67, Bogotá D.C, Colombia.
²² Andhra Pradesh Nurses & Midwives Council, Old Government General Hospital, Hanumanpet, Main Road, Vijayawada 520001 Andhra Pradesh, India.
²³ University of Padova, Via Nicolò Giustiniani, 2, 35128 Padova, PD, Italy.
²⁴ University of the Witwatersrand, Faculty of Health Sciences, 29 Princess of Wales Terrace, Parktown, Johannesburg 2193, South Africa.
²⁵ University of Michigan, C.S. Mott Children's Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.

PMID: 40752674
DOI: 10.1016/j.resuscitation.2025.110746

Free article

Ten steps to improve outcomes of in-facility neonatal resuscitation

Elizabeth E Foglia et al. Resuscitation. 2025.

Free article

. 2025 Jul 31:110746.

doi: 10.1016/j.resuscitation.2025.110746. Online ahead of print.

Authors

Affiliations

¹ University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA; Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA. Electronic address: foglia@chop.edu.
² Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway; University of Stavanger, Kjell Arholms Gate 41, 4021 Stavanger, Norway.
³ University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA; Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
⁴ University of North Carolina School of Medicine, 101 Manning Dr, Chapel Hill, NC 27599, USA.
⁵ The Royal Women's Hospital, University of Melbourne, 20 Flemington Rd, Parkville, VIC 3050, Australia.
⁶ University of Colorado School of Medicine, 13121 E 17th Pl, Aurora, CO 80045, USA.
⁷ Laerdal Global Health, Tanke Svilandsgate 30, P.O. Box 377, N-4002 Stavanger, Norway.
⁸ Mbarara University of Science & Technology, P. O Box 1410, Mbarara, Uganda.
⁹ Escola Paulista de Medicina, Universidade Federal de Sao Paulo, R. Botucatu, 740 - Vila Clementino, São Paulo, SP 04023-062, Brazil.
¹⁰ Center for Implementation Sciences (CIS), Addis Ababa University, NBH1, 4killo King George VI StAddis Ketema Sub-city, Addis Ababa, Ethiopia.
¹¹ Department of Neonatology, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago 8330077, Chile.
¹² Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing 100034, China.
¹³ University of Nigeria, Obukpa Rd, Nsukka 410105 Enugu, Nigeria.
¹⁴ KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore 229899 Singapore.
¹⁵ Haydom Lutheran Hospital, R24G+F74, Haydom, Tanzania.
¹⁶ Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
¹⁷ Ankura Hospital for Women and Children, Opposite NH65, Bagh Ameer, Sumitra Nagar Colony, Kukatpally, Hyderabad, Telangana 500072, India.
¹⁸ St. John's Medical College Hospital, Bangalore 560034, India.
¹⁹ Saxonian Center for Feto/Neonatal Health, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
²⁰ Government Hospital Dodoma, RP9V+3Q2, Hospital Rd, Dodoma, Tanzania.
²¹ Hospital Militar Central-Tv, 3C, 49-02 Bogotá D.C/Clínica de Marly Cl.50 # 9-67, Bogotá D.C, Colombia.
²² Andhra Pradesh Nurses & Midwives Council, Old Government General Hospital, Hanumanpet, Main Road, Vijayawada 520001 Andhra Pradesh, India.
²³ University of Padova, Via Nicolò Giustiniani, 2, 35128 Padova, PD, Italy.
²⁴ University of the Witwatersrand, Faculty of Health Sciences, 29 Princess of Wales Terrace, Parktown, Johannesburg 2193, South Africa.
²⁵ University of Michigan, C.S. Mott Children's Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.

PMID: 40752674
DOI: 10.1016/j.resuscitation.2025.110746

Abstract

Background: Up to 10 % of all newborns require assistance to breathe at birth. Although neonatal resuscitation guidelines and educational platforms exist, best practices to implement high-quality neonatal resuscitation care have not been defined.

Aim: To establish a Neonatal Global Resuscitation Alliance and develop ten steps to improve outcomes of in-facility neonatal resuscitation across global settings.

Methods: Three-stage iterative consensus-based process: (1) invited input from the neonatal resuscitation community to identify pertinent measures, (2) convened a face-to-face meeting of 28 global neonatal resuscitation content experts to refine consensus steps, (3) presented draft steps and related content to stakeholders; solicited public comment and revised ten steps based on feedback.

Results: The consensus-based ten steps include: Implement effective education systems; Ensure team and equipment readiness; Identify high-risk pregnancies and prevent perinatal risks; Respond to every birth; Perform guideline based resuscitation; Deliver guideline based post-resuscitation care; Collect data throughout resuscitation care; Improve quality of resuscitation; Support parent and family well-being; Cultivate a culture of excellence. For each of these steps, key concepts and suggested approaches to put the steps into practice are identified.

Conclusion: These ten steps to improve outcomes of in-facility neonatal resuscitation represent a clear framework for healthcare professionals, institutions, and policymakers to evaluate and strengthen their readiness, training, and response to newborns who need resuscitation at birth. This consensus-based guidance can be used to optimize in-facility neonatal resuscitation and improve outcomes for newborns worldwide.

Keywords: Global resuscitation alliance; Neonatal resuscitation; Ten steps.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: “Asmita Acharya reports a relationship with Laerdal Global Health that includes: employment. Jackie Patterson reports a relationship with Laerdal Global Health that includes: funding grants. Vinay Nadkarni reports a relationship with National Institutes of Health that includes: funding grants. Vinay Nadkarni reports a relationship with Agency for Healthcare Research and Quality that includes: funding grants. Vinay Nadkarni reports a relationship with US Department of Defense that includes: funding grants. Vinay Nadkarni reports a relationship with Zoll Medical that includes: funding grants. Vinay Nadkarni reports a relationship with Laerdal Foundation that includes: funding grants. Vinay Nadkarni reports a relationship with Nihon Kohden that includes: funding grants. Vinay Nadkarni reports a relationship with Philips that includes: funding grants. Vinay Nadkarni reports a relationship with Society of Critical Care Medicine that includes: board membership. Vinay Nadkarni reports a relationship with International Liaison Committee on Resuscitation that includes: board membership. Vinay Nadkarni reports a relationship with Citizen COR Foundation that includes: board membership. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.”.

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Ten steps to improve outcomes of in-facility neonatal resuscitation

Affiliations

Ten steps to improve outcomes of in-facility neonatal resuscitation

Authors

Affiliations

Abstract

Conflict of interest statement

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