Abstract
The 2025 updates to the Neonatal Resuscitation Program (NRP) 9th edition and European Resuscitation Council (ERC) guidelines represent a comprehensive evolution in perinatal care, driven by rigorous evidence synthesis from the International Liaison Committee on Resuscitation (ILCOR). This article analyzes key revisions aimed at mitigating global neonatal mortality through the newly introduced “Newborn Chain of Care” framework. Significant clinical shifts include the recommendation for deferred cord clamping (DCC) of at least 60 s for vigorous infants, and the endorsement of intact umbilical cord milking (I-UCM) for non-vigorous term and late preterm neonates to improve hemodynamic stability.
Respiratory management protocols have been refined, notably advising an initial FiO2 ≥ 0.30 for preterm infants (<32 weeks) and softening the stance against 100% oxygen initiation for term infants where titration is impossible, though 21% remains preferred. The guidelines also embrace technological advancements, recommending video laryngoscopy to improve intubation success and emphasizing supraglottic airways (SGAs) as a critical rescue intervention. Conversely, practices such as routine suctioning of clear fluid and the sodium bicarbonate administration during arrest have been retired. The scope of training is expanded to include modules on congenital heart disease (CHD) and neonatal intensive care unit (NICU)-based resuscitation. While these updates promise improved survival and neurodevelopmental outcomes, this review highlights the challenges of translating technology-dependent recommendations into low-resource settings, emphasizing the need for equitable equipment distribution and interdisciplinary team training to bridge the gap between evidence and practice.
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