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Resuscitation Council UK: review of updated 2021 neonatal life support guideline
  1. Chloe Pemberton,
  2. Claire Howarth
  1. NICU, Homerton University Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Chloe Pemberton, Neonatology, Homerton University Hospital NHS Foundation Trust, London E9 6SR, UK; chloe.pemberton{at}

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National guidance on neonatal life support (NLS) is regulated by the Resuscitation Council UK, and the NLS guidelines were updated in May 2021. This process was led by systematic reviews by the International Liaison Committee on Resuscitation (ILCOR) in collaboration with the European Resuscitation Council and accredited by the National Institute for Health and Care Excellence. The NLS algorithm (figure 1) is the hallmark in guidance for newborn resuscitation. In this guideline review, we discuss the key changes made to practice, explore the current and ongoing controversies in neonatal resuscitation and review emerging evidence, which may shape future guidance.

Figure 1

Neonatal life support algorithm. Reproduced with the kind permission of Resuscitation Council UK.

Key issues addressed by this updated guideline

The 2021 NLS guideline has many updated changes (box 1), and below we address the key changes that will impact practice.

Box 1

What is new?

  • In management of the umbilical cord, clamping after at least 60 s is recommended, but if this is not possible cord milking is an option in babies >28 weeks’ gestation.

  • In non-vigorous infants born through meconium, immediate laryngoscopy with or without suction after delivery is not recommended. 

  • Laryngeal mask may be considered in infants of ≥34 weeks’ gestation (>~2000 g) if face mask ventilation or tracheal intubation is unsuccessful.

  • Initial delivered oxygen concentration depends on gestation: 

    • ≥32 weeks’ gestation: 21% oxygen 

    • 28–32 weeks: 21%–30% oxygen

    • <28 weeks: 30% oxygen

  • Both initial and subsequent intravenous/intraosseous epinephrine doses are 20 μg kg−1 (0.2 mL kg−1 of 1:10 000 epinephrine (1000 μg in 10 mL)); in the absence of a response to cardiopulmonary resuscitation (CPR), give repeat doses every 3–5 min.

  • Stopping resuscitation should be considered and discussed if there has been no response after 20 min and reversible problems have been excluded. 

In management of the umbilical cord, delayed cord clamping after at least 60 s is recommended, but if this is not possible umbilical cord milking is an option in babies >28 weeks’ gestation.

Delayed cord clamping (DCC) is defined as the practice of delaying clamping the umbilical cord to allow for increased placental blood flow to the infant. The benefits have been well established: two meta-analyses looking at term infants and those born …

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  • Contributors CP wrote and edited the manuscript. CH edited the manucript. Both authors approved the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.