NLS

Temperature control & stimulation	Remove wet towels Dry and cover apart the face the head and body of the mannequin with provided warm towels Perform a brief period of tactile stimulation	Newborns get cold very easily, which leads to cold stress and impaired adaptation Preheating the radiant warmer and drying keeps the newborn warm Stimulation helps to induce effective heart rate and breathing
Initial assessment	Newborn with inadequate breathing, low or undetectable heart rate and reduced tone needs further support Judge the heart rate by listening to the apex beat with a stethoscope Check the breathing by looking for chest movements and by bilateral auscultation Check the muscle tone	Accurately assessment indicates, whether the baby is responding to previous efforts and whether further support is needed Heart rate is the most sensitive indicator A very floppy baby is likely to need resuscitation
Airway & initial inflation	Position the mannequin's head in neutral position on a shoulder roll Suction the oropharynx Avoid aggressive and to deep suction Apply five positive pressure inflations with 30 cm H2O and maintain inflation for 2‐3 s	Airway might be obstructed and must be open before the baby can inflated effectively Newborns have a relatively prominent occiput, which tends to flex the neck if the baby is placed on a flat surface Fluid, mucus, blood clots, vernix or meconium in the oropharynx might obstruct the airway Aggressive pharyngeal suction can cause laryngeal spasm and vagal bradycardia Lungs are filled with fluid and expansion of the lungs require initial inflation pressures of 30 cm of H20 for 2‐3 s
Re‐assess	Observe whether chest passively moves with each inflation Evaluate heart rate and breathing If chest and heart rate does not rise, then reposition mask and newborn's head, consider oropharyngeal re‐suction Repeat initial five inflations and ensure that lungs have been aerated successfully	Lung aeration has been achieved Successful aeration of the lungs leads to prompt rise of the pulse Correct for mask leakage and airway obstruction Lungs must be inflated before effective ventilation and/or chest compression can be delivered
Ventilation	If heart rate increases between 60‐100 bpm, then continue ventilation at rate of 30/min each for 1 s Continue ventilation until the newborn establishes regular breathing and heart rate maintains above 100 bpm	Newborn's breathing is insufficient to provide heart with sufficient oxygen and needs further respiratory support
Chest compressions	If heart rate remains below 60 bpm or is undetectable after confirmed initial lung inflations, start chest compressions Place index‐middle fingers of the left hand over the lower third of the sternum Compress the sternum quickly and firmly to a depth of one‐third of the anterior‐posterior diameter of the chest Allow chest wall to return to its relaxed position between compressions Use 3:1 compression to ventilation ratio Achieve a rate of 100‐120 events per minute Continue circulatory support until spontaneous heart rate is faster than 60 bpm	Newborn lacks sufficient breathing and circulation despite effective inflation Deep compressions establish blood flow and cardiopulmonary circulation Heart refills with blood during relaxation phase Recommended ratio provides regular breaths with an physiological rate of 30/min Compromise of gas exchange is most cause of postnatal cardiovascular collapse
Re‐assess	Assess every 30 s the newborn Stop ventilation if baby start to cry and evaluation shows maintained pulse > 100 bpm, regular breathing and increasing tone with legs and arms movements	Heart rate and breathing change rapidly in newborns First sign of any improvement will be an increase in heart rate
Post‐resuscitation care	Wrap the mannequin in a second warm towel and avoid cooling Place pulse oximeter on the right hand Start monitoring pre‐ductal oxygenation and heart rate	After NLS the newborn is at risk of later deteriorating and needs closely assessments Oxygen saturation from other extremities than from right hand is expected lower because of right‐to‐left shunting through the arterial duct after birth