Top Things to Know: 2023 American Heart Association and American Academy of Pediatrics Focused Update on Neonatal Resuscitation

Published: November 16, 2023

Prepared by Melissa Mahgoub, PhD

The plan for umbilical cord management depends on gestational age at birth and other clinical factors such as the need for resuscitation.
For term and preterm infants who do not require resuscitation, delayed cord clamping for 30 seconds or more can be beneficial.
For nonvigorous term and late preterm infants born at 35-42 weeks, intact cord milking may be reasonable compared to early cord clamping.
For preterm infants born at 28-34 weeks and in whom delayed cord clamping cannot be performed, intact cord milking may be reasonable.
For preterm infants born at less than 28 weeks, intact cord milking is not recommended.
Effective positive pressure ventilation is the priority in newborn infants who need support after birth.
A T-piece resuscitator is preferred for delivering positive-pressure ventilation compared to a self-inflating bag.
T-piece resuscitators and flow-inflating bags require a compressed gas source.
A self-inflating bag should be available as a backup in the event of compressed gas failure.
Use of a supraglottic airway may be considered as the primary interface to administer positive-pressure ventilation instead of a face mask for newborn infants born at 34 or more weeks.

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