Taulukko «...»1 kokoaa ILCORin Neonatal Life Support (NLS) -työryhmän kaikki PICOST-aiheet (systematic review, scoping review, evidence update). Katsauksien johtopäätökset on esitetty erikseen täysiaikaisten (term) ja ennenaikaisten (preterm) osalta, aina kun se on tieteellisesti ja kliinisesti tarpeen.
| Vastasyntyneen elvytys-suosituksen osio | Population | Systematic review, scoping review, or evidence update by ILCOR (Reference) | PICO (Population – Intervention- Comparator-Outcome) | Treatment recommendation | Strength of recommendation and certainty of evidence, GRADE (number refers to the treatment recommendation) |
|---|---|---|---|---|---|
| Elvytykseen varautuminen | All fullterm and preterm infants | Effect of Briefing Before Neonatal Resuscitation «Neonatal Life Support: 2025 International Liaison ...»1 | P: Healthcare professionals involved in neonatal resuscitation I: Pre-resuscitation briefing C: No briefing O: Infant, family, and staff outcomes |
1. Whenever the need for resuscitation of a newborn is anticipated, perform a multidisciplinary pre-resuscitation briefing, including communication between the neonatal, obstetric, and midwifery teams to establish the neonatal management plan. | 1. Good practice statement |
| Napanuoran sulkeminen | Nonvigorous Term and Late Preterm Infants (≥34 weeks' gestation) | Umbilical cord management at birth for nonvigorous term and late preterm infants «Davis PG, El-Naggar W, Ibarra Rios D ym. Cord mana...»2 |
P: Term and late preterm infants (≥34 weeks' gestation) who are not vigorous at birth I: Cord management strategies to improve fetal-to-neonatal transition (deferred cord clamping, intact-cord resuscitation, intact umbilical cord milking, or cut umbilical cord milking) C: Immediate cord clamping or alternative cord management strategies O: Neonatal mortality, neurodevelopmental impairment, hypoxic-ischemic encephalopathy, need for chest compressions, NICU admission, jaundice requiring exchange transfusion or phototherapy, hematologic outcomes, hypothermia, postpartum hemorrhage, postpartum infection, and maternal mortality or severe morbidity. |
1. Use intact umbilical cord milking rather than immediate cord clamping in term and
late preterm infants (≥34 weeks' gestation) who remain non-vigorous despite stimulation.
2. No recommendation can be made for or against intact cord resuscitation in term and late preterm infants who are non-vigorous at birth because of insufficient evidence. 3. Continue to provide tactile stimulation while the umbilical cord remains intact whenever deferred cord clamping or intact cord milking is performed. |
1 Weak recommendation, low-certainty evidence 2. No recommendation 3 Good practice statement |
| Napanuoran sulkeminen | Vigorous Term and Late Preterm Infants (≥34 weeks' gestation) | Umbilical cord management at birth for vigorous term and late preterm infants «El-Naggar W, Davis PG, Soll RF ym. Cord Management...»3, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Vigorous term and late preterm infants (≥34 weeks' gestation) I: Deferred cord clamping, intact cord milking, or cut-cord milking C: Immediate cord clamping or alternative cord management strategies O: Neonatal mortality, hypoxic-ischemic encephalopathy, need for resuscitation, respiratory distress, NICU admission, hematologic outcomes, neurodevelopmental impairment, ferritin concentration, maternal mortality, postpartum hemorrhage, manual placental removal, and postpartum infection. |
1. Defer umbilical cord clamping for at least 60 seconds in vigorous term and late preterm infants (≥34 weeks' gestation) who do not require immediate resuscitation at birth. | 1. Weak recommendation, very low-certainty evidence |
| Napanuoran sulkeminen | Preterm Infants < 37 gestational weeks | Umbilical cord management at birth for preterm infants «Neonatal Life Support: 2025 International Liaison ...»1, «El-Naggar W, Davis PG, Josephsen J ym. Cord Manage...»4 | P: Preterm infants (<37 weeks' gestation) and their mothers I: Deferred cord clamping or umbilical cord milking C: Immediate cord clamping or deferred cord clamping versus umbilical cord milking O: Infant mortality, neonatal morbidity, maternal mortality, maternal complications, need for resuscitation, blood transfusion, hematologic and cardiovascular outcomes, and hyperbilirubinemia requiring phototherapy. |
1. Defer umbilical cord clamping for at least 60 seconds in preterm infants (<37 weeks'
gestation) who do not require immediate resuscitation at birth. 2. Consider umbilical cord milking as an alternative to immediate cord clamping in infants born at 28+0 to 36+6 weeks' gestation when deferred cord clamping is not performed. 3. Do not use intact umbilical cord milking in infants born at <28 weeks' gestation. 4. No recommendation can be made regarding cord management in preterm infants (<37 weeks' gestation) who require immediate resuscitation at birth because of insufficient evidence. 5. Individualize cord management in maternal, fetal, or placental conditions that were excluded from most studies, taking maternal and neonatal risks into account. 6. Discuss the cord management plan with obstetric and neonatal teams and the parents before delivery whenever possible, taking individual maternal and infant circumstances into account. |
1. Strong recommendation, moderate-certainty evidence 2. Conditional recommendation, low-certainty evidence 3. Weak recommendation, low-certainty evidence 4. Weak recommendation, low-certainty evidence 5. Weak recommendation, very low-certainty evidence 6. Good practice statement |
| Lämpötalous | Late preterm and term infants (≥34 weeks' gestation) | Maintaining normal temperature «Ramaswamy VV, de Almeida MF, Dawson JA, ym. Mainta...»5 immediately after birth in term and late preterm infants «Neonatal Life Support: 2025 International Liaison ...»1 | P: Late preterm and term infants (≥34 weeks) immediately after birth I: Thermal interventions to maintain normothermia C: Standard care or no intervention O: Survival, normothermia, thermal instability, resuscitation outcomes, morbidity |
1. Maintain delivery room temperature at approximately 23°C for late preterm and term
infants (≥34 weeks) to reduce the risk of hypothermia. 2. Use immediate skin-to-skin care with a parent after birth in infants at low risk of requiring resuscitation to maintain normal temperature. 3. Consider using a plastic bag or wrap when skin-to-skin care is not feasible to help maintain normal temperature. 4. Routine use of a plastic bag or wrap in addition to skin-to-skin care cannot be recommended because current evidence is insufficient to determine the balance of benefits and harms. |
1. Weak recommendation, very low-certainty evidence 2. Weak recommendation, very low-certainty evidence 3. Weak recommendation, very low-certainty evidence 4. No recommendation |
| Lämpötalous | Preterm Infants <34 weeks' gestation | Maintaining normal temperature immediately after birth in preterm infants «Dawson JA, Ramaswamy VV, de Almeida MF ym. on beha...»6, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Preterm infants (<34 weeks' gestation) immediately after birth I: Thermal interventions to maintain normothermia (e.g., increased room temperature, plastic wrap/bag, thermal mattress, radiant warmer, heated humidified gases) C: Standard thermal care or alternative thermal interventions O: Survival, normothermia, thermal instability, response to resuscitation, and major neonatal morbidity. |
1. Maintain delivery room temperature at ≥23°C to reduce the risk of hypothermia.
2. Consider using a thermal mattress when admission hypothermia is a concern, while monitoring for hyperthermia. 3. Use a plastic bag or wrap immediately after birth to maintain normothermia. 4. Monitor and manage body temperature to prevent hyperthermia. 5. Use a head covering to reduce heat loss and maintain normothermia. 6. Consider heated and humidified respiratory gases when admission hypothermia is a recognized problem and resources are available. 7. No recommendation can be made regarding servo-controlled versus manual radiant warmers because of insufficient evidence. 8, No recommendation can be made regarding routine skin-to-skin care immediately after birth because of insufficient evidence; however, skin-to-skin care may be considered when other effective thermal measures are limited. |
1. Weak recommendation, very low-certainty evidence 2. Conditional recommendation, low-certainty evidence 3. Strong recommendation, moderate-certainty evidence 4. Good practice statement 5. Strong recommendation, moderate-certainty evidence 6. Conditional recommendation, very low-certainty evidence 7. No recommendation 8. Good practice statement |
| Stimulointi | Fullterm and preterm infants | Tactile stimulation «de Almeida MF, Guinsburg R, Isayama T ym. Tactile ...»7, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Term and preterm newborn infants with absent, intermittent, or shallow respirations
immediately after birth I: Tactile stimulation in addition to routine thermal care C: Routine handling and thermal care alone O: Survival, neurodevelopment, spontaneous breathing, need for PPV, time to HR ≥100 bpm, NICU admission, and respiratory morbidity. |
1, Provide tactile stimulation in addition to routine thermal care for newborn infants
with absent, intermittent, or shallow respirations immediately after birth. 2. Do not delay initiation of positive-pressure ventilation if inadequate respirations persist despite tactile stimulation. |
1. Weak recommendation, very low-certainty evidence 2. Good practice statement |
| Ilmateiden puhdistaminen imulla, kirkas lapsivesi | Fullterm and preterm infants, clear amniotic fluid | Suctioning of clear amniotic fluid at birth «Fawke J, Wyllie JP, Udeata E ym. Suctioning clear ...»8http://ilcor.org, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Neonates born through clear amniotic fluid I: Initial oro/nasopharyngeal suctioning C: No initial suctioning O: Need for assisted ventilation, advanced resuscitation, oxygen supplementation, adverse effects, and unanticipated NICU admission. |
1. Do not perform routine suctioning of the mouth and nose in newborn infants born
through clear amniotic fluid. 2. Consider airway positioning and suctioning only when airway obstruction is suspected. |
1. Weak recommendation, very low-certainty evidence 2. Good practice statement |
| Ilmateiden puhdistaminen imulla, vihreä lapsivesi | Non-vigorous term and near-term infants (≥34 weeks' gestation) meconium-stained amniotic fluid | Tracheal Intubation and Suctioning of «Strand ML, Lee HC, Kawakami M ym. Tracheal suction...»9 Meconium-Stained Amniotic Fluid «Neonatal Life Support: 2025 International Liaison ...»1 | P: Non-vigorous infants (≥34 weeks' gestation) born through meconium-stained amniotic
fluid I: Immediate laryngoscopy with or without tracheal suctioning C: Immediate resuscitation without laryngoscopy O: Survival, neurodevelopment, meconium aspiration syndrome, respiratory outcomes, delivery room interventions, and length of hospitalization. |
1. Do not perform routine immediate direct laryngoscopy with or without tracheal suctioning
in non-vigorous newborn infants born through meconium-stained amniotic fluid. 2. Consider tracheal intubation and suctioning only when airway obstruction is suspected or needs to be relieved. |
1. Weak recommendation, low-certainty evidence 2. Good practice statement. |
| Sykkeen arviointi | All fullterm and preterm infants | Heart rate assessment methods in the delivery room—diagnostic characteristics «Kawakami MD, Kapadia VS, Strand M ym. Methods of h...»10, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Newborn infants in the delivery room I: Heart rate assessment using auscultation, palpation, pulse oximetry, Doppler, digital stethoscope, photoplethysmography, dry electrode technology, or other novel methods C: Electrocardiography (ECG) or other heart rate assessment methods O: Accuracy of heart rate assessment, time to first heart rate assessment after device placement, and time to first heart rate assessment after birth. |
1. Use ECG for heart rate assessment immediately after birth when accurate heart rate
estimation is needed and resources are available. 2. Use pulse oximetry or auscultation as alternatives to ECG, while recognizing their limitations. 3. No recommendation can be made regarding the use of other devices for heart rate assessment because of insufficient evidence. 4. Use auscultation, with or without pulse oximetry, to confirm heart rate when ECG is unavailable, not functioning, or pulseless electrical activity is suspected. |
1. Conditional recommendation, low-certainty evidence. 2. Conditional recommendation, low-certainty evidence 3. No recommendation 4. Good practice statement |
| Sykkeen arviointi | Fullterm and preterm infants | Heart rate assessment methods in the delivery room—clinical outcomes «Kapadia VS, Kawakami MD, Strand M ym. Methods of h...»11, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Newborn infants in the delivery room I: Heart rate assessment using ECG, Doppler, digital stethoscope, photoplethysmography, dry electrode technology, or other novel methods C: Pulse oximetry with or without auscultation, auscultation alone, or other heart rate assessment methods O: Duration of positive-pressure ventilation, tracheal intubation, advanced resuscitation, time to HR ≥100 bpm, resuscitation team performance, NICU admission, and mortality. |
1. Use ECG for heart rate assessment during delivery room resuscitation when resources
are available. 2. Use auscultation with pulse oximetry as an alternative when ECG is unavailable, while recognizing the limitations of these methods. 3. No recommendation can be made regarding the use of digital stethoscopes, Doppler ultrasound, dry electrode technology, photoplethysmography, or transcutaneous diaphragmatic electromyography because of insufficient evidence. 4. Use auscultation, with or without pulse oximetry, to confirm heart rate when ECG is unavailable, not functioning, or pulseless electrical activity is suspected. |
1. Weak recommendation, low-certainty evidence 2. Weak recommendation, low-certainty evidence 3. No recommendation 4. Good practice statement |
| Lisähapen alkusäädöt | Late preterm and term infants (≥35 gestational weeks) | Oxygen concentration for initiating resuscitation in late preterm and term infants «Isayama T, Dawson JA, Roehr CC ym. Initial oxygen ...»12, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Term and late preterm newborn infants (≥35 weeks' gestation) requiring respiratory
support at birth I: Lower initial oxygen concentration (FiO₂ <0.50) C: Higher initial oxygen concentration (FiO₂ ≥0.50) O: Short- and long-term mortality, neurodevelopmental impairment, and hypoxic-ischemic encephalopathy. |
1. Use an initial oxygen concentration of 21% for term and late preterm newborn infants
(≥35 weeks' gestation) requiring respiratory support at birth. 2. Do not use an initial oxygen concentration of 100% for term and late preterm newborn infants requiring respiratory support at birth. |
1. Weak recommendation, low-certainty evidence 2. (Strong recommendation, low-certainty evidence |
| Lisähapen alkusäädöt | Preterm infants < 35 gestational weeks | Oxygen concentration for initiating resuscitation in preterm infants «Roehr CC, Weiner GM, Isayama T ym. Initial oxygen ...»13 | P: Preterm newborn infants (<35 weeks' gestation) requiring respiratory support at
birth I: Lower initial oxygen concentration (FiO₂ ≤0.50) C: Higher initial oxygen concentration (FiO₂ >0.50) O: Mortality, neurodevelopmental impairment, major IVH, retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, resuscitation response, and oxygenation. |
1. Use an initial oxygen concentration of at least 30% for newborn infants <32 weeks'
gestation requiring respiratory support at birth. (Weak recommendation, low-certainty
evidence) 2. No recommendation can be made regarding the initial oxygen concentration for infants born at 32 to 34+6 weeks' gestation because of insufficient evidence. |
1. Weak recommendation, low-certainty evidence 2. No recommendation |
| Ventilaatio, välineet | Fullterm and preterm infants | Devices for Administering Positive-Pressure Ventilation «Trevisanuto D, Roehr CC, Davis PG ym. Devices for ...»14, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Newborn infants receiving positive-pressure ventilation during resuscitation I: Ventilation using a T-piece resuscitator, flow-inflating bag, or self-inflating bag (with or without PEEP valve) C: Alternative ventilation devices or configurations O: Mortality, severe intraventricular hemorrhage, bronchopulmonary dysplasia, advanced resuscitation, air leak, intubation, duration of PPV, length of stay, and NICU admission |
1. Use a T-piece resuscitator rather than a self-inflating bag for positive-pressure
ventilation at birth when resources are available. Keep a self-inflating bag available
as a backup in case of gas supply failure. 2. No recommendation can be made regarding the use of a T-piece resuscitator versus a flow-inflating bag because of insufficient evidence. 3. No recommendation can be made regarding the use of a flow-inflating bag versus a self-inflating bag because of insufficient evidence. 4. No recommendation can be made regarding the use of self-inflating bags with versus without a PEEP valve because the available evidence is insufficient. |
1. Weak recommendation, very low-certainty evidence 2. No recommendation 3. No recommendation 4. No recommendation |
| Kurkunpäämaskin käyttö maskiventilaation sijasta | Fullterm and preterm infants (≥34 gestational weeks) | Supraglottic airway device versus face mask «Yamada NK, McKinlay CJD, Quek BH ym. Supraglottic ...»15, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Newborn infants ≥34 weeks' gestation receiving positive-pressure ventilation during
resuscitation I: Supraglottic airway device C: Face mask ventilation O: Ventilation failure, intubation, time to HR >100 bpm, duration of positive-pressure ventilation, advanced resuscitation, soft tissue injury, NICU admission, air leak, mortality, and neurodevelopmental impairment |
1. Use a supraglottic airway device instead of a face mask for positive-pressure ventilation in newborn infants ≥34 weeks' gestation when resources and training are available. | 1.Weak recommendation, low-certainty evidence |
| Kurkunpäämaskin käyttö intubaation sijasta | Fullterm and preterm infants (≥34 gestational weeks) | Supraglottic airway device versus tracheal tube «Perlman JM, Wyllie J, Kattwinkel J ym. on behalf o...»16, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Newborn infants ≥34 weeks' gestation receiving positive-pressure ventilation during
resuscitation I: Supraglottic airway device C: Tracheal intubation O: Successful airway placement, time to insertion, ventilation effectiveness, time to HR >100 bpm, duration of positive-pressure ventilation, advanced resuscitation, soft tissue injury, NICU admission, air leak, mortality, and neurodevelopmental impairment. |
1. Use a laryngeal mask as an alternative to tracheal intubation when face mask ventilation
is unsuccessful in late preterm and term newborn infants (≥34 weeks' gestation). 2. Use a laryngeal mask when tracheal intubation is not feasible after failed positive-pressure ventilation in late preterm and term newborn infants (≥34 weeks' gestation). |
1. Weak recommendation, low-certainty evidence 2. Strong recommendation, good practice statement |
| Kurkunpäämaskin käyttö paineluelvytyksen aikana | Fullterm and preterm infants | Use of a supraglottic airway device during chest compressions «Ramachandran S, Soh QH, and Wyckoff MH on behalf o...»17 | P: Newborn infants ≥34 weeks' gestation requiring chest compressions despite optimized
positive-pressure ventilation I: Positive-pressure ventilation via a supraglottic airway device C: Positive-pressure ventilation via a face mask or tracheal tube O: Delivery room survival, time to HR ≥60 and ≥100 bpm, airway placement, CPR interruption, epinephrine administration, device failure, pulmonary outcomes, survival to hospital discharge, hypoxic-ischemic encephalopathy, airway complications, length of hospital stay, and neurodevelopmental impairment. |
1. Use a supraglottic airway device for ventilation during chest compressions in newborn infants ≥34 weeks' gestation when tracheal intubation is not possible or has been unsuccessful. | 1. Good practice statement |
| Ylipainetuen käyttö | Preterm Infants | Continuous positive airway pressure versus positive pressure ventilation for preterm infants «Perlman JM, Wyllie J, Kattwinkel J ym. on behalf o...»16, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Spontaneously breathing preterm infants with respiratory distress requiring respiratory
support in the delivery room I: Continuous positive airway pressure (CPAP) C: Intubation and intermittent positive-pressure ventilation (IPPV) O: Death or bronchopulmonary dysplasia, mortality, bronchopulmonary dysplasia, air leak, necrotizing enterocolitis, severe intraventricular hemorrhage, and severe retinopathy of prematurity |
1. Use continuous positive airway pressure (CPAP) as the initial respiratory support for spontaneously breathing preterm infants with respiratory distress rather than tracheal intubation and positive-pressure ventilation. | 1. Weak recommendation, moderate-certainty evidence |
| Ylipainetuen käyttö | Term and Late Preterm Infants With Respiratory Distress ≥34+0 weeks gestation | Continuous positive airway pressure for term and late preterm infants with respiratory distress «Shah BA, Fabres JG, Szyld EG ym. Continuous positi...»18, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Spontaneously breathing infants ≥34 weeks' gestation with or at risk of respiratory
distress during transition after birth I: Continuous positive airway pressure (CPAP) with or without supplemental oxygen C: No CPAP with or without supplemental oxygen O: NICU admission, tracheal intubation, chest compressions, duration of respiratory support, air-leak syndromes, mortality, and length of hospital stay. |
1. No recommendation can be made regarding the routine use of continuous positive airway pressure (CPAP) for spontaneously breathing late preterm and term newborn infants with respiratory distress because of insufficient evidence | 1. No recommendation |
| Pidennetty sisäänhengitys | Fullterm and preterm infants | Sustained inflations during newborn resuscitation «Kapadia VS, K Urlesberger B, Soraisham A ym. Susta...»19, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Newborn infants requiring positive-pressure ventilation for bradycardia or ineffective
respirations at birth I: Positive-pressure ventilation initiated with sustained inflations (>1 s) C: Positive-pressure ventilation with intermittent inflations (≤1 s); O: Mortality, long-term neurodevelopment, mechanical ventilation, air leaks, bronchopulmonary dysplasia, severe intraventricular hemorrhage, and severe retinopathy of prematurity. |
1. Do not use initial sustained inflations longer than 5 seconds routinely in preterm
newborn infants requiring positive-pressure ventilation at birth. 2. No recommendation can be made regarding the optimal duration of initial inflations for term and late preterm newborn infants requiring positive-pressure ventilation because of insufficient evidence. |
1. Weak recommendation, low-certainty evidence 2. No recommendation |
| Uloshengityksen CO2-ilmaisimen käyttö | Fullterm and preterm infants | Exhaled CO2 monitoring to guide noninvasive ventilation «Solevåg AL, Monnelly VJ, Josephsen JB ym. Exhaled ...»20, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Newborn infants receiving non-invasive intermittent positive-pressure ventilation
at birth I: Exhaled CO₂ monitoring in addition to clinical assessment, pulse oximetry, and/or ECG C: Clinical assessment, pulse oximetry, and/or ECG alone O: Tracheal intubation, resuscitation outcomes, survival, time to HR >100 bpm, duration of positive-pressure ventilation, chest compressions, and major neonatal morbidity. |
1. No recommendation can be made regarding the use of exhaled CO₂ monitoring to guide non-invasive positive-pressure ventilation in newborn infants immediately after birth because of insufficient evidence. | 1. No recommendation |
| Videolaryngoskoopin käyttö | Fullterm and preterm infants | Video versus traditional laryngoscope «Fawke J, Antoine J, Costa-Nobre DT ym. on behalf o...»21 | P: Infants requiring tracheal intubation at birth or in the neonatal unit I: Video laryngoscopy C: Direct (traditional) laryngoscopy O: Mortality, successful intubation, first-attempt success, number of intubation attempts, time to intubation, intubation-related adverse events, clinician-reported intubation difficulty, and intraventricular hemorrhage. |
1. Use video laryngoscopy instead of direct laryngoscopy for tracheal intubation when resources and training are available, particularly for less-experienced clinicians. | 1. Conditional recommendation, moderate-certainty evidence |
| Hengitysfunktiomonitorin käyttö vastasyntyneen elvytyksessä | Fullterm and preterm infants | Respiratory function monitoring during resuscitation «Fuerch JH, Rabi Y, Thio M ym. Respiratory Function...»22at birth «Neonatal Life Support: 2025 International Liaison ...»1 | P: Newborn infants receiving respiratory support at birth I: Respiratory function monitoring (RFM) display C: No respiratory function monitoring display O: Mortality, severe intraventricular hemorrhage, resuscitation performance, ventilation characteristics (tidal volume, mask leak), delivery room intubation, pneumothorax, duration of respiratory support, and bronchopulmonary dysplasia. |
1. No recommendation can be made regarding the use of respiratory function monitoring during respiratory support at birth because of insufficient evidence. | 1. Low-certainty evidence |
| NIRSin käyttö elvytyksen aikana | Fullterm and preterm infants | Near-infrared spectroscopy «Monnelly V, Nakwa F, Josephsen JB ym. Near Infrare...»23 during positive pressure ventilation | P: Newborn infants receiving CPAP, positive-pressure ventilation, or both during stabilization
or resuscitation at birth I: Cerebral oxygen saturation (crSO₂) monitoring with a treatment guideline in addition to clinical assessment, pulse oximetry, or ECG C: Clinical assessment, pulse oximetry, or ECG alone O: Survival without neurodevelopmental impairment, survival, neurodevelopmental impairment, resuscitation response, oxygen exposure, and severe intraventricular hemorrhage. |
1. No recommendation can be made regarding the use of regional cerebral oxygen saturation (crSO₂) monitoring with a treatment guideline during respiratory support immediately after birth because of insufficient evidence. | 1. Very low-certainty evidence |
| Paineluelvytys, aloitussyke | Fullterm and preterm infants | Heart Rate for Commencing «Ramachandran S, Bruckner M, Wyckoff MH, Schmölzer ...»24 Chest Compressions «Neonatal Life Support: 2025 International Liaison ...»1 | P: Neonates requiring ventilation during resuscitation with persistent bradycardia I: Initiation of chest compressions at heart rates other than <60 bpm C: Initiation of chest compressions at a heart rate <60 bpm O: Survival, neurological outcomes, and time to return of spontaneous circulation. |
1. Initiate chest compressions when the heart rate remains <60 bpm despite optimized ventilation. | 1. Good practice statement |
| Paineluelvytys, tekniikka | Fullterm and preterm infants | Chest compressions with 2 thumbs versus other techniques «Neonatal Life Support: 2025 International Liaison ...»1, «Ramachandran S, Bruckner M, Wyckoff MH, Schmölzer ...»24 | P: Neonates receiving chest compressions during resuscitation I: Chest compression techniques other than the two-thumb technique C: Two-thumb chest compression technique O: Survival, neurological outcomes, and time to return of spontaneous circulation. |
Use the two-thumb, hands-encircling-the-chest technique as the preferred method for chest compressions in newborn infants immediately after birth. | 1. Weak recommendation, very low-certainty evidence |
| Paineluelvytys, lisähappi paineluelvytyksen aikana | Fullterm and preterm infants | Supplemental «Ramachandran S, Bruckner M, Wyckoff MH, Schmölzer ...»24 oxygen during chest compressions «Neonatal Life Support: 2025 International Liaison ...»1 | P: Neonates receiving chest compressions during resuscitation I: Lower oxygen concentration than 100% during ventilation C: 100% oxygen during ventilation O: Survival, neurological outcomes, time to return of spontaneous circulation (ROSC), and oxidative injury. |
1. Increase the supplemental oxygen concentration when chest compressions are required
if effective ventilation with lower oxygen concentrations has not restored spontaneous
circulation. 2. Wean supplemental oxygen as soon as the heart rate has recovered. |
1.Good practice statement 2. Weak recommendation, very low-certainty evidence |
| Paineluelvytys, ventilation ja painelun suhde | Fullterm and preterm infants | Compression-to-ventilation ratio «Ramachandran S, Bruckner M, Wyckoff MH, Schmölzer ...»24, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Neonates receiving chest compressions during resuscitation I: Chest compression-to-ventilation ratios other than 3:1 (e.g., 5:1, 9:3, 15:2, or continuous/synchronous compressions) C: Standard 3:1 chest compression-to-ventilation ratio O: Survival, time to return of spontaneous circulation (ROSC), hemodynamic parameters, tissue oxygenation, inflammatory markers, and compressor fatigue. |
1. Use a 3:1 chest compression-to-ventilation ratio during neonatal resuscitation. | 1. Weak recommendation, very low-certainty evidence |
| Paineluelvytys, monitorointi | Fullterm and preterm infants | Use of feedback cardiopulmonary resuscitation (CPR) devices for neonatal cardiac arrest «Ramachandran S, Bruckner M, Wyckoff MH, Schmölzer ...»24, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Neonates receiving chest compressions during resuscitation I: Use of feedback devices (e.g., end-tidal CO₂ monitoring, pulse oximetry, or automated compression feedback devices) C: Clinical assessment of chest compression effectiveness O: Hands-off time, time to return of spontaneous circulation (ROSC), perfusion, survival, and neurological outcomes. |
1. Do not rely routinely on a single feedback device (e.g., end-tidal CO₂ monitoring or pulse oximetry) to detect return of spontaneous circulation (ROSC) in asystolic or bradycardic newborn infants. | 1. Weak recommendation, very low-certainty evidence |
| Paineluelvytys, painelun syvyys | Fullterm and preterm infants | Depth of chest compressions «Ramachandran S, Bruckner M, Wyckoff MH, Schmölzer ...»24, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Neonates receiving chest compressions during resuscitation I: Chest compression depth other than one-third of the anteroposterior chest diameter C: Chest compression depth of one-third of the anteroposterior chest diameter O: Survival, neurological outcomes, and time to return of spontaneous circulation (ROSC). |
1. Compress the chest one third the anterior-posterior diameter (good practice statement). |
1. Good practice statement |
| Paineluelvytys, painelupaikka | Fullterm and preterm infants | Chest compression location on sternum «Ramachandran S, Bruckner M, Wyckoff MH, Schmölzer ...»24, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Neonates receiving chest compressions during resuscitation I: Chest compressions at locations other than the lower one-third of the sternum C: Chest compressions over the lower one-third of the sternum O: Survival, neurological outcomes, and time to return of spontaneous circulation (ROSC). |
1. Deliver chest compressions over the lower one-third of the sternum, avoiding the xiphoid process. | 1. Good practice statement |
| Suoniyhteys ja intraosseaaliyhteys | Fullterm and preterm infants | Intraosseous versus intravenous «Mandira D Kawakami, Juin Yee Kong ym. on behalf of...»25, cannulation «de Almeida MF, Guinsburg R, Velaphi S ym. Intraven...»26 for emergency access «Neonatal Life Support: 2025 International Liaison ...»1 | P: Newborn infants with cardiac arrest requiring chest compressions (in hospital or
out of hospital) I: Intraosseous (IO) vascular access for drug administration C: Intravenous (IV; umbilical venous) access for drug administration O: Mortality, long-term neurodevelopmental outcomes, return of spontaneous circulation (ROSC), brain injury, severe intraventricular hemorrhage/periventricular leukomalacia, time to establish vascular access, and access-related complications. |
1. Use umbilical venous catheterization as the primary route for vascular access during
newborn resuscitation in the delivery room. If umbilical venous access is not feasible,
use intraosseous (IO) access as an alternative. 2. Outside the delivery room, use either umbilical venous or intraosseous (IO) access for administration of fluids and medications during newborn resuscitation. |
1. Weak recommendation, very low-certainty evidence 2. Weak recommendation, very low-certainty evidence |
| Adrenaliinin käyttö | Fullterm and preterm infants | Epinephrine (adrenaline) for neonatal resuscitation «Liley HG, Kim H-S, Mildenhall L ym. Dose, route an...»27 | P: Neonates (<28 days of age, any gestational age) with absent cardiac output, asystole,
or a heart rate <60 bpm despite ventilation and chest compressions I: Non-standard epinephrine (adrenaline) dose, interval, or route of administration C: Intravenous epinephrine (adrenaline) 0.01–0.03 mg/kg administered every 3–5 minutes O: Mortality, survival to neonatal unit admission, return of spontaneous circulation (ROSC), hypoxic-ischemic encephalopathy, severe intraventricular hemorrhage, other major neonatal morbidities, and neurodevelopmental outcomes. |
1. Administer intravenous epinephrine (0.01–0.03 mg/kg) if the heart rate remains
<60 beats/min despite optimized ventilation and chest compressions. 2. If intravenous access is not yet available, administer endotracheal epinephrine (0.05–0.1 mg/kg) while establishing vascular access. 3. Do not delay establishment of vascular access while administering endotracheal epinephrine. 4. Repeat epinephrine every 3–5 minutes, preferably via the intravenous route, if the heart rate remains <60 beats/min. 5. If the response to endotracheal epinephrine is inadequate, administer an intravenous dose as soon as vascular access is established, regardless of the dosing interval. |
1. Weak recommendation, very low-certainty evidence 2. Weak recommendation, very low-certainty evidence 3. Weak recommendation, very low-certainty evidence 4. Weak recommendation, very low-certainty evidence 5. Weak recommendation, very low-certainty evidence |
| Natriumbikarbonaatin käyttö | Fullterm and preterm infants | Sodium bicarbonate during neonatal resuscitation «Neonatal Life Support: 2025 International Liaison ...»1 | P: Neonates requiring resuscitation in the hospital I: Sodium bicarbonate administration C: No sodium bicarbonate administration O: Survival, return of spontaneous circulation (ROSC), hypoxic-ischemic encephalopathy, severe intraventricular hemorrhage, other major neonatal morbidities, and neurodevelopmental outcomes. |
1. The previous recommendation for sodium bicarbonate administration during neonatal resuscitation has been withdrawn because the available evidence is insufficient to support a treatment recommendation. | 1. Previous recommendation withdrawn. |
| Glukoosin käyttö | Fullterm and preterm infants | Glucose management during or immediately afterresuscitation «McKinlay CJD, Quek BH, Yeo CL ym. for the Neonatal...»28 | P: Newborn infants (preterm and term) receiving resuscitation at birth I: Blood glucose monitoring and management strategies, including glucose administration or post-resuscitation care bundles C: No monitoring, no glucose treatment, or alternative monitoring or management strategies O: Resuscitation success, neonatal brain injury, long-term neurological outcomes, neonatal morbidity, dysglycemia, metabolite levels, and feasibility. |
1. Measure blood glucose early after resuscitation and monitor serial blood glucose
concentrations until normoglycemia is achieved. 2. Guide intravenous glucose therapy by blood glucose measurements to avoid both hypoglycemia and hyperglycemia.) |
1. Good practice statement 2. Good practice statement |
| Nestetäyttö | Fullterm and preterm infants | Blood volume expansion during neonatal resuscitation «Neonatal Life Support: 2025 International Liaison ...»1 | P: Term and preterm newborn infants with a heart rate <60 beats/min after chest compressions
and epinephrine and/or suspected hypovolemia during resuscitation I: Blood volume expansion with blood, colloid, crystalloid, or other fluids C: No blood volume expansion O: Survival, neurodevelopmental outcomes, time to return of spontaneous circulation (ROSC), need for vasopressor infusions, blood pressure, pulmonary edema, and major neonatal morbidity. |
1. Administer early volume expansion with crystalloid or packed red blood cells in
newborn infants with suspected or confirmed blood loss who do not respond to resuscitation.
2. Do not use routine volume expansion in newborn infants without evidence of blood loss. A trial of volume expansion may be considered if occult blood loss is suspected and the infant remains unresponsive to ventilation, chest compressions, and epinephrine. |
1. Strong recommendation, good practice statement 2. Good practice statement |
| Elvytyksen jälkeinen hoito: hypotermian korjaaminen | Fullterm and preterm infants | Effect of rewarming rate on outcomes for newborn infants who are unintentionally hypothermic after delivery «Rüdiger M, Kawakami MD, Madar J ym. Effect of rewa...»29, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Newborn infants with hypothermia (<36.0°C) on admission I: Rapid rewarming (≥0.5°C/hour) C: Slow rewarming (<0.5°C/hour) O: Mortality, neurodevelopmental impairment, need for respiratory support, hypoglycemia, seizures, length of hospital stay, intraventricular hemorrhage, periventricular leukomalacia, and necrotizing enterocolitis. |
1. Rewarm unintentionally hypothermic newborn infants after birth. There is insufficient
evidence to recommend either rapid (≥0.5°C/hour) or slow (<0.5°C/hour) rewarming.
2. Use a standardized rewarming protocol with frequent or continuous temperature monitoring to avoid hyperthermia. 3. Monitor blood glucose during rewarming because of the risk of hypoglycemia. |
1. No recommendation 2.Good practice statement 3. Good practice statement |
| Viilennyshoito (kehittyvät ympäristöt) | Fullterm and preterm infants | Therapeutic hypothermia in limited-resource settings «Lee H, Costa-Nobre D, Katheria A ym. on behalf of ...»30, «Neonatal Life Support: 2025 International Liaison ...»1 | P: Late preterm and term infants (≥34 weeks' gestation) with moderate or severe hypoxic-ischemic
encephalopathy managed in low-resource settings I: Therapeutic hypothermia to a defined target temperature for a specified duration C: Standard care O: Death or neurodevelopmental impairment, mortality, neurodevelopmental impairment, cerebral palsy, blindness, deafness, persistent pulmonary hypertension, and other adverse outcomes. |
1. Use therapeutic hypothermia for term infants (≥37 weeks' gestation) with evolving
moderate-to-severe hypoxic-ischemic encephalopathy in low- and middle-income countries
when an appropriate level of neonatal intensive care is available. 2. No recommendation can be made regarding therapeutic hypothermia for late preterm infants (34+0 to 36+6 weeks' gestation) because of insufficient evidence. 3. Perform therapeutic hypothermia only according to established protocols and in neonatal units with appropriate multidisciplinary expertise, monitoring, and resources. |
1. Weak recommendation, low-certainty evidence 2. No recommendation 3. Good practice statement |
| Vastasyntyneen elvytyksen jatkaminen ja kesto | Fullterm and preterm infants | Impact of Duration of Intensive Resuscitation «Neonatal Life Support: 2025 International Liaison ...»1 | P: Newborn infants with persistent asystole, bradycardia (heart rate <60 beats/min),
or pulseless electrical activity requiring cardiopulmonary resuscitation for at least
10 minutes after birth I: Continuing cardiopulmonary resuscitation beyond 10 minutes after birth C: Discontinuing cardiopulmonary resuscitation at 10 minutes after birth O: Survival, neurodevelopmental outcomes, and survival without moderate or severe neurodevelopmental impairment. |
1. Consider discontinuing resuscitative efforts if there is no return of spontaneous
circulation after 10–20 minutes of comprehensive resuscitation and reversible causes
have been excluded. Discuss the decision with the resuscitation team and the family. 2. A reasonable timeframe to consider changing the goals of care is around 20 minutes after birth. |
1. Weak recommendation, very low-certainty evidence 2. Weak recommendation, very low-certainty evidence |
| Vanhempien läsnäolo vastasyntyneen elvytyksessä | Fullterm and preterm infants | Family presence during neonatal «Dainty KN, Atkins DL, Breckwoldt J, ym. Family pre...»31 resuscitation «Neonatal Life Support: 2025 International Liaison ...»1 | P: Children with cardiac arrest in any setting I: Family presence during resuscitation C: No family presence during resuscitation O: Patient outcomes, family-centered outcomes, and clinician-centered outcomes. |
1. Allow parents to be present during neonatal resuscitation when circumstances, facilities,
and parental preference permit. 2. There is insufficient evidence to determine whether parental presence during neonatal resuscitation improves patient or family outcomes. |
1. Weak recommendation, very low-certainty evidence 2. No recommendation |
| Jälkipuinti elvytyksessa | Fullterm and preterm infants | Debriefing of clinical resuscitation performance: EIT 6307 TF SR «Nabecker S, Cortegiani A, Breckwoldt J ym. on beha...»32 | P: Healthcare providers performing resuscitation in any clinical setting I: Post-event clinical debriefing C: No post-event clinical debriefing O: Resuscitation skills performance, resuscitation knowledge, neurological outcome, survival to hospital discharge, and event survival. |
1. Perform post-event clinical debriefing after adult, pediatric, and neonatal cardiac arrest when adequate resources are available. Post-event debriefing may improve resuscitation performance and patient outcomes, and no undesirable effects have been demonstrated. | 1. Weak recommendation, low-certainty evidence |
| Jälkipuinti vastasyntyneen elvytyksessä | Fullterm and preterm infants | Effect of Briefing and Debriefing Following Neonatal Resuscitation «Yamada N, Stave C, Fawke J. Use of Briefing and De...»33 on Patient/Clinician/Parent Outcomes | P: Healthcare professionals involved in the resuscitation or simulated resuscitation
of a neonate I: Briefing and/or debriefing C: No briefing or debriefing O: Outcomes for infants, families, and healthcare staff. |
1. Use briefing and debriefing to improve short-term clinical performance and adherence
to neonatal resuscitation practices. (Weak recommendation, low-certainty evidence)
2. Consider video-assisted debriefing and structured checklists to improve team communication and adherence to resuscitation guidelines. (Weak recommendation, low-certainty evidence) 3. Rapid cycle deliberate practice (RCDP) may improve short-term performance during simulated neonatal resuscitation, but its effects on skill retention and clinical outcomes remain uncertain. (Weak recommendation, low-certainty evidence) 4. There is insufficient evidence to determine the effects of briefing or debriefing on long-term clinical outcomes for infants, families, or healthcare staff. (Insufficient evidence) |
1. Weak recommendation, low-certainty evidence 2. Weak recommendation, low-certainty evidence 3. Weak recommendation, low-certainty evidence 4. No recommendation, insufficient evidence |