2025 American and European Guidelines on Neonatal Resuscitation: Concordance and Differences

Area of Science:

• Neonatal resuscitation
• Pediatric critical care
• Evidence-based medicine

Background:

• The American Heart Association-American Academy of Pediatrics (AHA-AAP) and European Resuscitation Council (ERC) released updated neonatal resuscitation guidelines in October 2025.
• Both guidelines are based on International Liaison Committee on Resuscitation (ILCOR) evaluations but present differences in scope, structure, and clinical recommendations.

Purpose of the Study:

• To compare the 2025 AHA-AAP and ERC neonatal resuscitation guidelines.
• To identify and analyze areas of divergence between the two guideline documents.
• To reach a qualitative consensus on the clinical importance of identified differences.

Main Methods:

• Narrative review of the 2025 AHA-AAP and ERC neonatal resuscitation guidelines.
• Focus on algorithm design, initial stabilization, ventilation strategies, and oxygen administration.
• Qualitative analysis of guideline differences and their clinical implications.

Main Results:

• Both guidelines advocate for a gentle, physiology-based approach to neonatal transition and family-centered care.
• Key differences exist in resuscitation algorithm complexity, ventilation management, and initial inspired oxygen concentration recommendations.
• Many identified differences stem from variations in guideline scope rather than conflicting evidence interpretation.

Conclusions:

• Despite a shared evidence base, the 2025 AHA-AAP and ERC guidelines exhibit notable divergences in specific recommendations.
• Several recommendations are based on limited data and expert consensus, highlighting areas for future research.
• Further high-quality research is crucial for harmonizing neonatal resuscitation practices globally.