- Antenatal counseling and team briefing
- Equipment/warmer check, suction, PPV devices, oxygen blender, pulse-ox, EKG leads
Preparation before birth
The first minute after birth
Three key questions
- Term gestation?
- Good tone?
- Breathing or crying?
If all yes → infant remains with parent for routine care: warm, maintain temperature, position airway, clear secretions if needed, dry, and continue evaluation.
If any answer is “No”
- Warm & maintain temperature
- Position airway, clear secretions if needed, dry, stimulate
Ventilation pathway
Apnea/gasping or HR < 100?
- Begin positive-pressure ventilation (PPV)
- Attach pulse-ox; consider ECG monitor
Labored breathing or persistent cyanosis?
- Position & clear airway, monitor SpO₂
- Supplemental oxygen as needed; consider CPAP
Heart-rate checkpoints
After PPV — is HR < 100?
- Check chest movement; perform ventilation corrective steps (MR SOPA)
- Consider ETT or laryngeal mask if needed
Is HR < 60?
- Intubate (if not already), begin chest compressions
- Coordinate with PPV using 100% O₂; add ECG monitor
- Consider emergency UVC
If HR remains < 60
- Give IV epinephrine
- If persistent bradycardia, consider hypovolemia and pneumothorax
Targeted preductal SpO₂ after birth
| Time after birth | SpO₂ target | Referral |
|---|---|---|
| 1 min | 60%–65% | SpO₂ Targets |
| 2 min | 65%–70% | |
| 3 min | 70%–75% | |
| 4 min | 75%–80% | |
| 5 min | 80%–85% | |
| 10 min | 85%–95% |
Cited Keywords & Referral Links
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Bottom line
In the delivery room, think warm-position-clear-dry-stimulate, then ventilate early if apnea/gasping or HR < 100. If HR drops below 60 despite effective ventilation, intubate, coordinate compressions with PPV and 100% oxygen, establish UVC, and give epinephrine. Target SpO₂ ranges and debrief after every event.
This guide is for education and does not replace clinical judgment or local NRP protocols.