The authoritative flowchart, on the ANZCOR site (© ANZCOR). We link to it rather than copy it, so it stays current. The notes below are an educational summary, not the algorithm.
Call for help early. Call 2222 and ask for a neonatal emergency. If more help is required, call 2222 and ask for advanced neonatal resuscitation. Involve the registrar / consultant, and call NETS (1300 36 2500) if the baby is unwell or may need retrieval.
AssessAt birth - three questions
- Term? Good tone? Breathing or crying?
- Yes to all: stay with mother, delayed cord clamping (>=60s), skin-to-skin, keep warm.
- No: move to the warmer and start the steps.
StabiliseThe first 60 seconds
- Warm: radiant warmer; for <32 weeks place straight into a polyethylene bag + hat (do not dry).
- Airway: neutral / sniffing position; suction only if visibly obstructed.
- Stimulate: dry and rub.
- Assess heart rate (best indicator) and breathing.
VentilateNot breathing, or HR <100
- Start positive pressure ventilation at ~40-60 breaths/min.
- Air (21%) for term and >=34 weeks; start 30% for <34 weeks; titrate to the SpO2 targets below.
- Look for chest rise. If none, work through the corrective steps (MR SOPA: mask seal, reposition, suction, open mouth, pressure up, airway / alternative).
- Avoid routine prolonged sustained inflations.
Targeted pre-ductal SpO2 (ANZCOR)
| Minutes of life | Acceptable pre-ductal SpO2 |
|---|
| 1 min | 60-70% |
| 2 min | 65-85% |
| 3 min | 70-90% |
| 4 min | 75-90% |
| 5 min | 80-90% |
| 10 min | 85-90% |
CompressionsHR <60 despite 30s of effective ventilation
- Increase oxygen to 100%.
- Start chest compressions, 3:1 with ventilation (about 90 compressions + 30 breaths per minute).
- Two-thumb technique, lower third of sternum, depth about 1/3 of the chest.
- Reassess HR after ~30s.
AdrenalineHR still <60
- Adrenaline - IV / UVC 10-30 microgram/kg (0.1-0.3 mL/kg of 1:10,000), repeat every 3-5 min.
- ETT route (50-100 microgram/kg) only if no vascular access, and is less reliable.
- Consider volume: 0.9% sodium chloride 10 mL/kg if blood loss / hypovolaemia.
- Confirm doses against your local guideline.
Educational summary - follow current
ANZCOR Newborn Life Support guidance and your local algorithm. APGAR scores (1, 5 and 10 min) describe the baby; they do not direct resuscitation - keep reassessing HR and breathing.