Newborns go through a complex set of physiologic changes to successfully transition to extrauterine life. These changes quickly shift responsibility for gas exchange from the placenta to the newborn’s lungs. The infant’s initial breaths and respiratory effort are the catalyst; they drive up intrapulmonary pressures and help clear fetal lung fluid. Increased blood oxygen content decreases pulmonary vascular resistance, increases pulmonary blood flow, and facilitates closure of the foramen ovale and patent ductus arteriosus, which previously shunted blood away from fetal lung circulation. Just as a newborn’s efforts at ventilation are key to a successful transition after birth, the most important part of newborn resuscitation is effective ventilation.

In 2015, the Neonatal Resuscitation Program (NRP) published updated guidelines for neonatal resuscitation. Key additions to the 2015 NRP algorithm include consideration of using 3-lead electrocardiography (ECG) to monitor heart rate (HR) and initiating intubation before chest compressions. The guidelines now recommend...

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