How consistent are recent neonatal resuscitation guidelines?

Background: Approximately 10% of neonates require respiratory or cardiovascular support at birth, making evidence-based neonatal resuscitation guidelines critical to clinical practice. Methods: This narrative review compares the most recent neonatal resuscitation guidelines published by the American Heart Association/American Academy of Pediatrics (AHA/AAP), the Australian and New Zealand Committee on Resuscitation (ANZCOR), and the European Resuscitation Council (ERC), all derived from the 2025 International Liaison Committee on Resuscitation (ILCOR) recommendations. Results: While the three guidelines share common foundations, some notable differences exist in the method of grading and transparency of assessment of evidence certainty, and strength of recommendations. Key comparisons include umbilical cord management, airway and ventilation strategies, oxygen use, vascular access, and pharmacologic interventions during resuscitation. All guidelines recommend delayed cord clamping in vigorous infants, discourage routine airway suctioning for meconium-stained fluid, and support ventilation within 60 s of delivery when indicated. However, recommendations diverge regarding intact cord stabilization, cord milking in extremely preterm infants, initial oxygen concentrations, ventilation parameters, and the use of devices such as video laryngoscopes, laryngeal mask airways, and high-flow nasal cannula. Conclusion: Although the AHA/AAP, ANZCOR, and ERC neonatal resuscitation guidelines are all derived from the same ILCOR evidence summaries, important differences exist in their structure, transparency, and specific clinical recommendations. In part, differences in recommendations are due to a paucity of evidence around specific interventions. Standardized methods of reporting certainty of evidence and strength of recommendations may help clinicians deliver consistent, effective delivery room care.