Do the Newest Newborn Resuscitation Guidelines Agree? What Families Can Take From the 2025 American, European, and Australian-New Zealand Recommendations

A Plain-Language Look at Two 2026 Comparison Papers by Kuitunen and Davis and by Trevisanuto and Colleagues

In late 2025, three expert groups in North America, Europe, and Australia and New Zealand each updated their advice for helping babies who need extra help right after birth. Two research teams then compared those documents and found that they agree on the big things and differ mainly on small details, usually where scientists do not yet have firm answers. For families, the reassuring message is that the core care is the same everywhere, and the differences are being studied so that care keeps improving.

Why families may want to know this

Some babies need help to start breathing or to keep the heart working well after birth. Most of the time, a short period of support is enough and babies do well. Because many families will meet this situation, or hear about it from a friend or a news story, it is natural to wonder whether the doctors and nurses who care for newborns all follow the same playbook.

Two papers, published within weeks of each other

Two teams of doctors looked at exactly this question in 2026, a few weeks apart and working separately. Kuitunen and Davis[1] compared the guidelines from three groups: the American Heart Association together with the American Academy of Pediatrics, the European Resuscitation Council, and the Australian and New Zealand Committee on Resuscitation. Trevisanuto and colleagues[2] compared only the American and the European guidelines. Put side by side, one paper gives a three-way view and the other gives an American-versus-European view of the same material, and they come to very similar conclusions.

A note on what we could and could not read. The guideline documents themselves were not freely available to us, so everything we say about what they recommend comes from how these two comparison papers describe them. We have tried to stay close to what the papers report, and families who want the exact wording can ask their care team or look at the guidelines directly.

How a guideline is made, and why there are several

Think of it as a cookbook with a shared pantry. An international group called the International Liaison Committee on Resuscitation, or ILCOR, gathers and weighs the scientific studies and writes a summary of what the evidence shows[3]. Regional groups then turn that summary into practical instructions for their own doctors and nurses. The American guideline[4] and the European guideline[5] both came out in the autumn of 2025, and the Australian and New Zealand group published its own version, which we know only through the comparison papers.

None of this started in 2025. Earlier rounds include an international summary and an American guideline from 2020[6][7], and the American groups published a smaller update in 2023[8]. The international group has more recently been publishing summaries every year, with its 2024 one described as its eighth annual summary[9]. Many of the instructions carried forward. For example, the 2025 targets for how much oxygen should be in a baby's blood are described as similar to 2020, and the long-standing idea of reconsidering the goals of care after about 20 minutes of full resuscitation effort without improvement is still there[2].

Where all three guidelines agree

Here the news is very good. The comparison papers found a solid shared core[1][2]. When a baby is born and is doing well enough, all three groups favor waiting before clamping and cutting the umbilical cord, so the baby can keep receiving blood from the placenta. All three advise against squeezing blood along the cord toward the baby, which is called milking, in babies born before 28 weeks of pregnancy. All advise against routinely suctioning babies who passed their first stool, called meconium, before birth. All advise against very long, sustained breaths given by a mask in premature babies. And all agree on the heart-rate level, below 60 beats per minute, at which chest compressions would begin.

Both the American and European guidelines also advise against routinely giving a medicine called sodium bicarbonate, and both stress keeping babies warm, using a gentle approach based on how a newborn's body works, and involving families[2].

Where the guidelines differ

The differences are mostly in numbers and in how firmly something is recommended. Here are the main ones in everyday language.

Cord clamping: for premature babies, the American and European guidelines suggest waiting about 60 seconds, while the Australian and New Zealand guideline suggests at least 30 seconds for babies born before 34 weeks[1]. The European guideline also prefers, where it can be done safely, caring for the baby while the cord is still attached, which the American guideline mentions only as an open question[1][2]. Our article on resuscitation with the cord attached and our article on a large trial of two clamping approaches in very premature babies, the ABC3 trial, a multicenter study[10], explore this further.

Extra oxygen: for babies born before 32 weeks, the three groups suggest different starting levels of oxygen in the air given by the breathing support, from lower to higher[1][2]. This is the area with the most differences, and it is also an area where researchers are actively running studies. One large trial called TORPIDO 30/60 compared starting at 30% with starting at 60% oxygen in 1,469 premature babies and found no difference in survival or brain injury[11]. You can read more in our articles on oxygen targets and that trial. A separate study looked at high oxygen together with waiting to clamp the cord[12], covered in another article. An earlier trial of aiming for particular oxygen levels in premature babies also helped lay the groundwork[13].

Breathing support: the numbers for how gently or firmly to puff air into the lungs differ a little. The American guideline gives a single range of pressures, and the European guideline gives different pressures for babies born before or after 32 weeks[2]. Both are aiming for the same thing, which is to inflate the lungs without hurting them. A large trial called SAIL tested giving a long first breath to extremely premature babies[14], and all three groups now advise against doing that routinely. See our article on sustained inflation.

Equipment: the European guideline more strongly recommends a camera-equipped breathing-tube device, called a video laryngoscope, especially for less experienced staff, and the Australian and New Zealand group had not yet commented[1]. Small soft airway devices that sit above the voice box, called supraglottic airways, are allowed from about 34 weeks of pregnancy by the American and Australian and New Zealand guidelines, and the American and European guidelines accept them as the first device used to help breathing[1][2]. We discuss both in our articles on video laryngoscopes and supraglottic airways. A related question is how well the finger or foot sensor that measures oxygen works on different skin tones; see our article on pulse oximetry and skin pigmentation.

Why would careful experts differ when they read the same studies?

Kuitunen and Davis[1] put it simply: when strong studies are missing, differences between guidelines often reflect practical choices about where to draw a line, not a fundamental disagreement about what the studies show. There are a few reasons.

First, the three groups use different ways of rating how sure they are. One uses a scale of strong, moderate, and weak with letters for the quality of the evidence, one uses an international system with ratings from high to very low certainty, and one explains its reasoning in written text[1]. As a result the same dose of a medicine, in this case the emergency medicine epinephrine, can be called a strong recommendation in one document and a weak one in another[1]. This does not mean the dose is different; the amounts are the same written in different units.

Second, it is very hard to run studies on the tiniest, sickest babies, so for many questions the best evidence is limited. Kuitunen and Davis[1] note that some strong recommendations rest on weak evidence, and that the lack of well-run trials, especially in extremely premature babies, is the biggest limit.

Third, some of the differences are style. The American guideline is short and focused on specific questions, while the European one is longer and works like a stand-alone textbook chapter[2].

Trevisanuto and colleagues[2] suggest the guidelines are best seen as complementary rather than in conflict, and that the differences give researchers useful chances to compare what works best in real life.

What this means for your family

If your baby needed help at birth, it was very likely given according to the guideline your hospital follows, and that guideline shares the same core as the others. A difference in, say, how many seconds the team waited to clamp the cord is not a sign that anyone made a mistake. If you are curious, you can always ask your care team why something was done a certain way. Good teams welcome these questions.

There are also things the comparison papers did not cover, such as the details of chest compressions and the care babies receive after they have been stabilized, so we cannot say how the guidelines compare on those.

Looking ahead

The authors list questions that still need answers: the best way to handle the umbilical cord, how long the first breaths should last, which breathing mask or device works best, how much oxygen to start with, and the best route for emergency access to a baby's bloodstream[2]. As those studies are done, the guidelines may move closer together.

The takeaway

Three major guideline groups, working from the same scientific review, agree on the main steps and differ mostly in details where science is still catching up. That is how medicine ordinarily progresses, and it is good news that careful comparisons like these are being made[1][2].

References

  1. Kuitunen I, Davis PG. How consistent are recent neonatal resuscitation guidelines? Resuscitation Plus. 2026;29:101314. doi:10.1016/j.resplu.2026.101314 ↩
  2. Trevisanuto D, Ramaswamy VV, Nimbalkar S, Weiner GM. 2025 American and European guidelines on neonatal resuscitation: concordance and differences. Neonatology. 2026 May 20:1-8. doi:10.1159/000552450 ↩
  3. Liley HG, Weiner GM, Wyckoff MH, et al. Neonatal life support: 2025 International Liaison Committee on Resuscitation consensus on science with treatment recommendations. Pediatrics. 2026;157(1):e2025-074766. doi:10.1542/peds.2025-074766 ↩
  4. Lee HC, Strand ML, Finan E, et al. Part 5: Neonatal resuscitation: 2025 American Heart Association and American Academy of Pediatrics guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2025;152(16_suppl_2). doi:10.1161/CIR.0000000000001367 ↩
  5. Hogeveen M, Monnelly V, Binkhorst M, et al. European Resuscitation Council guidelines 2025: newborn resuscitation and support of transition of infants at birth. Resuscitation. 2025;215:110766. doi:10.1016/j.resuscitation.2025.110766 ↩
  6. Wyckoff MH, Wyllie J, Aziz K, et al. Neonatal life support: 2020 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2020;142(16_suppl_1). doi:10.1161/CIR.0000000000000895 ↩
  7. Aziz K, Lee HC, Escobedo MB, et al. Part 5: Neonatal resuscitation: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16_suppl_2). doi:10.1161/CIR.0000000000000902 ↩
  8. Yamada NK, Szyld E, Strand ML, et al. 2023 American Heart Association and American Academy of Pediatrics focused update on neonatal resuscitation: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics. 2024;153(2):e2023065030. doi:10.1542/peds.2023-065030 ↩
  9. Greif R, Bray JE, Djärv T, et al. 2024 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: summary from the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation. 2024;150(24):e580-e687. doi:10.1161/CIR.0000000000001288 ↩
  10. Knol R, Brouwer E, van den Akker T, et al. Physiological versus time based cord clamping in very preterm infants (ABC3): a parallel-group, multicentre, randomised, controlled superiority trial. Lancet Reg Health Eur. 2025;48:101146. doi:10.1016/j.lanepe.2024.101146 ↩
  11. Oei JL, Kirby A, Travadi J, et al. Targeted oxygen for initial resuscitation of preterm infants: the TORPIDO 30/60 randomized clinical trial. JAMA. 2026;335(6):523. doi:10.1001/jama.2025.23327 ↩
  12. Katheria AC, Ines F, Lee HC, et al. Deferred cord clamping with high oxygen in extremely preterm infants: a randomized clinical trial. JAMA Pediatr. 2025;179(9):971. doi:10.1001/jamapediatrics.2025.2128 ↩
  13. Oei JL, Saugstad OD, Lui K, et al. Targeted oxygen in the resuscitation of preterm infants, a randomized clinical trial. Pediatrics. 2017;139(1):e20161452. doi:10.1542/peds.2016-1452 ↩
  14. Kirpalani H, Ratcliffe SJ, Keszler M, et al. Effect of sustained inflations vs intermittent positive pressure ventilation on bronchopulmonary dysplasia or death among extremely preterm infants: the SAIL randomized clinical trial. JAMA. 2019;321(12):1165. doi:10.1001/jama.2019.1660 ↩