A Critical Review of the 2025 International Liaison Committee on Resuscitation Treatment Recommendations for Resuscitating the Newly Born Infant.

The 2025 recommendations from the International Liaison Committee on Resuscitation are updated from the 2020 version. The algorithm is unchanged from 2015. Ten topics are addressed in the 2025 recommendations: Anticipation and preparation, Umbilical cord management, Initial steps, Assessment of heart rate at birth, Ventilation and oxygenation, Circulatory support, Drug and fluid administration, Post-resuscitation care, Prognostication during cardio-pulmonary resuscitation and Family presence. Among changes since 2020 are an update of umbilical cord handling. Assessment of heart rate is now including auscultation as well as pulse-oximetry. We identified 51 recommendations given for topics published between the 2020 and the 2025 versions. Of these, 19 were weak and only three were strong recommendations, 6 were conditional and 15 recommendations are classified as good practice. Seven had insufficient evidence to draw any conclusion, and one was not graded. The certainty of evidence was low or very low for 25 recommendations and moderate for four only.

Conclusion

The present recommendations for newborn resuscitation are improved; however, they are still based on weak evidence with mostly low or very-low certainty. This indicates extensive research to establish truly evidence-based recommendations for newborn resuscitation is still needed.