Newborn Life Support (NLS)

Resuscitation Council UK Newborn resuscitation and support of transition of infants at birth Guidelines 2025

Article Last Updated:04/03/2026

Changes made to this article:

Link to the latest 2025 Resuscitation Guidelines updated
Minor optimisations made to the flowchart

There were no major changes in the 2025 Resuscitation Council UK guidelines that affect UKMLA-relevant content

Date: 24/11/25

Background Information

APGAR score

APGAR score should be recorded routinely at 1 min and 5 min after birth

Component	0 points	1 points	2 points
Appearance	Blue / pale completely	Peripheral cyanosis only	Pink
Pulse (heart rate)	0	<100	>100
Grimace (reflex irritability)	No response to stimulation	Weak cry when stimulated	Strong cry when stimulated
Activity (tone)	Floppy	Some flexion	Active movement
Respiration	No breathing	Slow / irregular breathing	Strong cry

NLS Guidelines

Key Concepts

Inflation vs Ventilation Breaths

Inflation breaths	To be given if the newborn is not breathing or gasping at birth Aim: open collapsed alveoli and establish functional residual capacity Administration: 2-3 sec of inspiratory time per breath 5 are given back-to-back
Ventilation breaths	To be given if chest movement is present (indicative of patent airway and delivered volume) but heart rate <100 bpm Aim: maintain established lung volume and provide adequate ventilation Administration: ≤1 sec of inspiratory time per breath Regular breaths given 40-60 per min

Most causes of cardiac arrest in newborns are respiratory problems, instead of cardiac problems. More emphasis is put on optimising ‘Breathing’, if not managed well, any subsequent interventions (including CPR) would be ineffective.

CPR in NLS

CPR (chest compression to ventilation ratio of 3:1) should only be started if the heart rate is <60 bpm after 30 seconds of good quality ventilation

Do not mix up the CPR ratios in various age groups:

Neonates (0-28 days): 3:1
Children (1 month – puberty): 15:2
Adults: 30:2

Drugs in NLS

IV adrenaline (1:10,000) 0.2 mL/kg should be given after 30 seconds of effective ventilation and chest compressions

Other drugs to consider:

Glucose – to reduce the likelihood of hypoglycaemia in prolonged resuscitation
Isotonic crystalloid / O -ve blood – for suspected blood loss or shock unresponsive to other resuscitative measures
Sodium bicarbonate – for prolonged unresponsive resuscitation with intracardiac acidosis

NLS Algorithm

Discontinuing Resuscitation

Discuss stopping resuscitation if there has been no response after 20 minutes and reversible causes have been excluded.

References

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