Postnatal support of transition and resuscitation


Steidl MF, Buonocore G, Zimmermann L, Hellström-Westas L, Flemmer AW, Rüdiger M, Saugstad OD, Trevisanuto D, Vento M

Target group

Newborn infants, pregnant women with risk factors, their partners, and parents

User group

Healthcare professionals, neonatal units, hospitals, and health services

Statement of standard

Support of postnatal transition to extrauterine life is based on internationally consented guidelines, which are based on scientific evidence, and is performed in an appropriate structured and equipped environment by trained personnel.


Postnatal adaptation to extrauterine life is a complex process during which air breathing is established and circulatory changes take place. Difficulties may occur with transition in situations such as preterm birth and following perinatal asphyxia. These situations account for much of the associated neonatal mortality and morbidity. (1–4) Certain problems that arise during birth may be anticipated. (5) Transition should be supported appropriately and formal resuscitation instituted when necessary. High-risk deliveries should be attended by individuals trained in advanced resuscitation, but all healthcare professionals attending deliveries should be trained in basic neonatal resuscitation techniques. The International Liaison Committee on Resuscitation (ILCOR) provides comprehensive recommendations for the management at transition and resuscitation of the newborn infant, which are adapted by international bodies such as the European Resuscitation Council. (6–8) These recommendations are updated regularly, translated and adapted by the respective regional or national organisations. Training in the practical skills of resuscitation should be undertaken in all maternity settings, including all responsible disciplines, using a neonatal resuscitation courses. (see TEG Education & training)


Short-term benefits

  • Reduced mortality and morbidity (6,8)

Long-term benefits

  • Improved neurodevelopmental outcome (6,8)


Components of the standard

Component Grading of evidence Indicator of meeting the standard
For parents and family    
1. Pregnant women with risk factors and their partners are informed by healthcare professionals and counseled before birth. (see TEG Birth & transfer) B (High quality) Patient information sheet
2. Parents are informed by healthcare professionals about the possible need for support at transition and the risks thereof in infants at high-risk for resuscitation. B (Moderate quality) Patient information sheet
3. Parents are invited to be present during resuscitation. (8–10) A (High quality) Guideline
4. Parents are provided with opportunities to debrief following a resuscitation of their infant. B (High quality) Clinical record, parent feedback
For healthcare professionals    
5. A guideline on resuscitation, including post-resuscitation care, is adhered to by all healthcare professionals. (6,8) B (High quality) Guideline
6. Training on current resuscitation recommendations, guidelines and local equipment is attended by all responsible healthcare professionals using accredited courses. (6,8) (see TEG Education & Training) A (Moderate quality)
B (High quality)
Training documentation
7. Equipment needed for resuscitation is regularly checked. B (High quality) Guideline
For neonatal unit    
8. A guideline on neonatal resuscitation, including post-resuscitation care, and arrangements for transfer to expert services where necessary, is available and regularly updated. (6,8) B (High quality) Guideline
9. Information to support emergency calls is clearly displayed within the delivery suite and neonatal unit to cover:

  • further help (manpower)
  • consultation (knowledge)
  • neonatal transport
B (High quality) Guideline
10. Team debriefing after resuscitation is provided. B (High quality) Healthcare professional feedback
11. Healthcare professionals trained in resuscitation are available throughout the 24 hours. B (High quality) Audit report
For hospital    
12. Training on resuscitation including simulation scenarios is ensured. B (High quality) Training documentation
13. Facilities for appropriate resuscitation and for resuscitation training (e.g. mannequins for simulation) are provided. (11,12) A (High quality)
B (High quality)
Audit report
For health service    
14. A national guideline on neonatal resuscitation is available and regularly updated. B (High quality) Guideline

Where to go

Further development Grading of evidence
For parents and family  
For healthcare professionals  
  • Video recording of transition management is conducted and structured feedback is given. (13)
B (Moderate quality)
  • Provide emergency telemedicine consultation for neonatal resuscitation. (14)
A (Low quality)
For neonatal unit  
  • Establish debriefing rounds for resuscitation situations, including interdisciplinary work with psychologists.
B (Moderate quality)
  • Establish regular quality meetings within one week after delivery to check defined quality parameters of pre- and postnatal management (lung maturation, admission temperature etc.) together with nurses, midwifes, obstetricians, neonatologists, psychologists.
B (Moderate quality)
For hospital  
  • Establish the chance of bonding with the mother immediately after successful support of postnatal transition.
B (High quality)
For health service  
  • Support research into new techniques and approaches for neonatal resuscitation.
B (High quality)

Getting started

Initial steps
For parents and family
  • Parents are verbally informed by healthcare professionals about resuscitation.
For healthcare professionals
  • Offer prenatal counseling by neonatologists.
  • Attend training on basic neonatal resuscitation.
  • Establish centralisation for high-risk deliveries in advance.
For neonatal unit
  • Develop and implement a guideline on resuscitation.
  • Develop information material on neonatal transition phase and potential resuscitation for parents.
  • Provide adequate training for healthcare professionals.
For hospital
  • Support healthcare professionals to participate in resuscitation training.
  • Support healthcare professionals in implementing measures for quality improvement.
For health service
  • Develop and implement a national guideline on neonatal resuscitation.


  1. World Health Organization. Causes of child mortality [Internet]. WHO. 2016. Available from:
  2. World Health Organization. World Health Statistics data visualizations dashboard. Neonatal mortality [Internet]. WHO. 2016 [cited 2018 May 29]. Available from:
  3. Lehtonen L, Gimeno A, Parra-Llorca A, Vento M. Early neonatal death: A challenge worldwide. Semin Fetal Neonatal Med. 2017;22(3):153–60.
  4. Murphy SL, Mathews TJ, Martin JA, Minkovitz CS, Strobino DM. Annual Summary of Vital Statistics: 2013-2014. Pediatrics. 2017 Jun;139(6).
  5. Aziz K, Chadwick M, Baker M, Andrews W. Ante- and intra-partum factors that predict increased need for neonatal resuscitation. Resuscitation. 2008 Dec;79(3):444–52.
  6. Perlman JM, Wyllie J, Kattwinkel J, Wyckoff MH, Aziz K, Guinsburg R, et al. Part 7: Neonatal Resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (Reprint). Pediatrics. 2015 Nov;136 Suppl 2:S120-166.
  7. Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al. Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (Reprint). Pediatrics. 2015 Nov;136 Suppl 2:S196-218.
  8. Wyllie J, Bruinenberg J, Roehr CC, Rüdiger M, Trevisanuto D, Urlesberger B. European Resuscitation Council Guidelines for Resuscitation 2015 Section 7. Resuscitation and support of transition of babies at birth. Resuscitation. 2015;95:249–63.
  9. Baskett PJF, Steen PA, Bossaert L, European Resuscitation Council. European Resuscitation Council guidelines for resuscitation 2005. Section 8. The ethics of resuscitation and end-of-life decisions. Resuscitation. 2005 Dec;67 Suppl 1:S171-180.
  10. Dingeman RS, Mitchell EA, Meyer EC, Curley MAQ. Parent presence during complex invasive procedures and cardiopulmonary resuscitation: a systematic review of the literature. Pediatrics. 2007 Oct;120(4):842–54.
  11. Terrin G, Conte F, Scipione A, Aleandri V, Di Chiara M, Bacchio E, et al. New architectural design of delivery room reduces morbidity in preterm neonates: a prospective cohort study. BMC Pregnancy Childbirth [Internet]. 2016 Mar 23;16. Available from:
  12. Vento M, Aguar M, Leone TA, Finer NN, Gimeno A, Rich W, et al. Using intensive care technology in the delivery room: a new concept for the resuscitation of extremely preterm neonates. Pediatrics. 2008 Nov;122(5):1113–6.
  13. Gelbart B, Hiscock R, Barfield C. Assessment of neonatal resuscitation performance using video recording in a perinatal centre. J Paediatr Child Health. 2010 Jul;46(7–8):378–83.
  14. Fang JL, Collura CA, Johnson RV, Asay GF, Carey WA, Derleth DP, et al. Emergency Video Telemedicine Consultation for Newborn Resuscitations: The Mayo Clinic Experience. Mayo Clin Proc. 2016 Dec;91(12):1735–43.

November 2018 / 1st edition / next revision: 2023

Recommended citation

EFCNI, Steidl MF, Buonocore G et al., European Standards of Care for Newborn Health: Postnatal support of transition and resuscitation. 2018.

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