Neonatal Resuscitation Quick Equipment Checklist

A neonatal resuscitation equipment checklist typically covers five categories of gear that need to be verified before every delivery: thermal management, ventilation, airway clearance, monitoring, and vascular access. The checklist exists because equipment problems during resuscitation are common and consequential. One study at a neonatal intensive care unit in a resource-limited setting found that only about 13% of resuscitation setups were fully complete without any defect, while roughly a third had serious deficiencies in equipment preparation, medication availability, or warmer setup.¹ Running through every item before the baby arrives is not bureaucratic busywork; it is the single most reliable way to prevent fumbling in the first minutes of life.

Warming Equipment Comes First

Newborns lose heat fast, and cold stress can undermine every other resuscitation effort. The first item on most checklists is the radiant warmer, which should be switched on and pre-warmed before delivery. Radiant warmers use overhead heating elements and often include a feedback loop that adjusts output based on the baby’s skin temperature. Their main advantage is that they keep the infant fully visible and accessible, which matters when a team needs to work quickly.² The checklist should confirm the warmer is plugged in, functioning, and set to the correct mode.

Pre-warming the warmer matters more than many teams realize. Commercially available radiant warmers vary significantly in the temperature they deliver at the same power setting, meaning a baby can end up too cold or too hot depending on the device.³ Servo-control mode, which adjusts heat output to maintain a target skin temperature, reduces this risk but only works if the skin probe is functioning and properly placed. Teams should also stock warm towels or blankets and, for very preterm infants, a polyethylene bag or wrap to reduce evaporative heat loss. That wrap is easy to forget in the rush of a premature delivery, so it earns a dedicated line on the checklist.

For extremely premature babies, especially those born before about 30 weeks, radiant warmers alone may not be enough. These infants have immature skin that allows large amounts of water to evaporate, pulling heat with it. Incubators can control both temperature and humidity, which radiant warmers cannot, making them the better option once the baby is stabilized.² In settings where incubators are unavailable, conductive warmers that use phase-change materials can provide supplemental heat for several hours with much lower power requirements.

Ventilation Devices and Mask Sizing

The majority of newborns who need help at birth need help breathing. Positive-pressure ventilation is the single most important intervention in neonatal resuscitation, so the ventilation equipment gets the most attention on any checklist. Three devices are commonly used: the self-inflating bag, the flow-inflating bag, and the T-piece resuscitator. Each has trade-offs, and which one your unit stocks determines what else needs to be on the cart.

Self-inflating bags are the most widely available. They work without a compressed gas source, which makes them essential in low-resource settings and for transport. Their downside is inconsistency. In bench testing, the T-piece resuscitator delivered target pressures more precisely than either bag type, with much less variation from squeeze to squeeze.⁴ The self-inflating bag also delivered less positive end-expiratory pressure even with a PEEP valve attached, which matters for keeping the lungs open between breaths.⁴

In a large randomized trial comparing the T-piece to the self-inflating bag in over a thousand newborns at 26 weeks’ gestation or greater, both devices achieved a heart rate above 100 beats per minute at two minutes in a similar proportion of infants. The T-piece group did see lower peak pressures and a lower intubation rate in the delivery room.⁵ A systematic review and meta-analysis of multiple trials found that devices with flow control, like the T-piece, were associated with lower rates of bronchopulmonary dysplasia, less need for surfactant, and less time on mechanical ventilation.⁶ These advantages were especially relevant for premature infants, whose fragile lungs are more vulnerable to pressure swings.

Regardless of device choice, the checklist should verify that the bag or T-piece is connected, that the correct mask sizes are available (typically a term size and a preterm size, both round or anatomically shaped), and that the pressure relief valve or settings are within safe limits. For the T-piece, this means confirming the gas source is connected and the peak inspiratory and PEEP pressures are dialed in. A self-inflating bag should be tested with a squeeze against an occluded mask to confirm the pop-off valve works. And every setup needs a backup: if the primary device fails, a second ventilation option should be within arm’s reach.

Airway Clearance and Supraglottic Options

A bulb syringe and a suction catheter connected to wall suction (or a portable suction device) should be present at every delivery. Routine deep suctioning is no longer recommended for most newborns, but when meconium or other secretions obstruct the airway, you need suction immediately. For intubated infants who develop tracheal secretions, the procedure should be performed by at least two people, kept under 15 seconds per attempt, and use negative pressure below 100 mmHg.⁷ The checklist should include the correct catheter sizes and a functioning suction gauge.

Endotracheal intubation supplies belong on every resuscitation cart, but intubation is a skill that degrades quickly without practice. A laryngeal mask airway offers an alternative for providers who cannot intubate or when intubation fails. The standard neonatal size (size 1) fits babies weighing about 2 to 5 kilograms, and a smaller size (0.0) has become available for infants under 2 kg.⁸ Including a laryngeal mask on the checklist is particularly useful for units where intubation experience is limited, because it can be placed without a laryngoscope and provides a reliable airway for ventilation when face-mask ventilation is ineffective.

Oxygen Delivery and Blenders

The days of blasting 100% oxygen at every newborn are over. Current evidence supports starting resuscitation of very-low-birth-weight infants with a lower fraction of inspired oxygen, around 0.3 or so, and titrating upward by 10 to 20 percent every 30 seconds to reach a target oxygen saturation of roughly 80 to 85 percent by five minutes after birth.⁹ For term infants, guidelines generally recommend starting with room air (21% oxygen). This means the checklist needs to include an air-oxygen blender so providers can dial in precise concentrations, along with appropriately sized oxygen tubing, a flowmeter, and a reservoir if using a self-inflating bag (which does not deliver supplemental oxygen reliably without one).

A pulse oximeter is the standard tool for tracking oxygen saturation. The sensor goes on the baby’s right hand or wrist, which reflects pre-ductal saturation and gives a more accurate picture of what the brain is receiving. The checklist should include the oximeter itself, a neonatal sensor, and a reference card showing the expected saturation targets by minute (since normal saturation rises gradually over the first ten minutes and starting at a low number is completely normal).

Heart Rate Monitoring

Heart rate is the single most important indicator of whether resuscitation is working. Auscultation with a stethoscope is the traditional method, but it ties up a team member and is notoriously unreliable under stress. Pulse oximetry provides a continuous readout but tends to be slower and less precise than electrocardiography (ECG) for assessing heart rate at birth.¹⁰

ECG leads connected to a cardiac monitor give the fastest, most accurate readout. A systematic review found that while ECG monitoring did not change major clinical outcomes like death before discharge or the duration of ventilation, it did provide quicker feedback and, in at least one large nonrandomized study, was associated with a lower intubation rate.¹¹ Adding three-lead ECG pads and a compatible monitor to the resuscitation cart is increasingly standard at units that can afford the equipment. For the checklist, this means verifying that the monitor is on, the leads are accessible, and someone on the team knows how to apply them quickly without delaying ventilation.

Vascular Access and Medications

Most resuscitations never get past the ventilation stage, but when they do, vascular access is the next bottleneck. The preferred route in a newborn is the umbilical vein, which is large, accessible via the freshly cut cord, and does not require searching for peripheral veins on a tiny, vasoconstricted baby. The checklist should include a pre-flushed umbilical venous catheter (typically 3.5 or 5 French, depending on estimated size), a sterile tray with scalpel, ties, and forceps, and saline for flushing.

Estimating how far to insert the catheter is tricky. Several formulas based on birth weight exist, and none achieve perfect positioning every time. One commonly used formula tends to over-insert the catheter in a large proportion of cases, and a revised version reduced the over-insertion rate without increasing the risk of placing the catheter too low.¹² A recent analysis comparing five weight-based formulas found that different formulas performed better in different weight ranges, with no single formula achieving accurate positioning in all newborns.¹³ Having a reference card on the cart with the appropriate formula for your unit’s protocol, sorted by estimated weight, saves time during a crisis.

When umbilical access fails or is not available, intraosseous access is the backup. In older children and adults, drilling an IO needle into the tibia works on the first attempt over 80 to 95 percent of the time. In neonates, the picture is much less reassuring. A meta-analysis found a first-attempt success rate of roughly 54% in clinical studies and about 44% in cadaveric studies for preterm and term neonates.¹⁴ Across case series, success ranged from 50 to 100 percent depending on the setting and device used.¹⁵ IO needles belong on the cart as an emergency fallback, but teams should know that placing one in a neonate is harder than they might expect from their adult or pediatric experience.

Medications that may be needed during advanced resuscitation include epinephrine (in the correct neonatal dilution), normal saline for volume expansion, and sodium bicarbonate in some protocols. Pre-drawn or pre-labeled syringes with the correct concentrations and doses save critical seconds when things escalate.

How You Organize the Cart Matters

Having all the right equipment is only half the battle. If a nurse has to dig through drawers to find the right catheter size, the time cost can be substantial. An eye-tracking study of providers working through simulated resuscitation scenarios found that participants had complex visual search patterns when looking for equipment, with their gaze shifting roughly once per second across dozens of distinct areas on the cart.¹⁶ That level of visual searching eats into time and increases the chance of grabbing the wrong item.

One solution that has been tested is organizing the cart according to the steps of resuscitation (airway, breathing, circulation, drugs) using a turntable with silhouette templates that show exactly where each piece of equipment belongs. The silhouettes help less experienced staff identify and locate items quickly, and the transparent material prevents items from being hidden underneath.¹⁷ In a randomized simulation trial, a purpose-designed neonatal resuscitation cart reduced equipment retrieval times by 58 to 74 percent compared with a generic code cart, and every participant rated it easier to use.¹⁸ If your unit is using a repurposed adult crash cart, even just adding labeled compartments and silhouette guides can meaningfully speed up a resuscitation.

Low-Resource and Out-of-Hospital Settings

Not every birth happens in a hospital with a fully stocked resuscitation bay. In low-resource environments and community-based settings, the checklist has to flex. The core requirements remain the same: warmth, ventilation, and a way to clear the airway. Self-inflating bag-and-mask devices designed for reuse and easy cleaning are available at a fraction of the cost of hospital-grade equipment. In certain community settings where even bag-and-mask devices are unavailable, a tube-and-mask device has been considered as a temporary alternative, though it is probably less effective.¹⁹

In these settings, conductive warmers that use phase-change materials can provide heat for up to four to six hours without electricity, making them practical for births in facilities with unreliable power.² A clean towel, a functional suction device (even a simple bulb syringe), and a ventilation bag with the right-sized mask form a minimally viable kit that can save a life. The checklist for these settings may be shorter, but the pre-delivery verification step is arguably even more important, because there is no backup equipment down the hall.

Cleaning and Maintaining Reusable Equipment

A checklist is only as useful as the equipment on it, and reusable gear that is not properly cleaned between uses introduces a different kind of risk. Proper reprocessing of resuscitation equipment is vital for ensuring clean equipment is available and for preventing infection transmission to newborns.²⁰ Neonatal infections linked to improper disinfection of equipment have been documented, particularly in facilities with limited access to clean water and overcrowded nurseries.²¹

The checklist should include a step confirming that all reusable components, especially masks, tubing, and suction devices, have been disinfected since their last use. In high-resource settings, most facilities use single-use items or have dedicated reprocessing protocols. In low-resource settings, the reality is often more complicated: limited access to high-level disinfection supplies, shared equipment across multiple delivery rooms, and inconsistent protocols. Making equipment disinfection a visible checkbox rather than an assumed background task increases the odds that it actually happens.

What a Practical Pre-Delivery Check Looks Like

The checklist should take no more than a couple of minutes and can be structured as a quick walk-through of the cart, top to bottom:

Warmth: Radiant warmer on and pre-warmed, towels or blankets ready, polyethylene wrap available if preterm delivery is expected.
Airway: Bulb syringe and suction catheter present, suction set to appropriate pressure, laryngeal mask available for backup.
Breathing: Ventilation device connected and tested (squeeze-test for bags, pressure check for T-piece), correct mask sizes laid out, oxygen blender set to starting concentration, flowmeter on.
Monitoring: Pulse oximeter with neonatal sensor, ECG leads and monitor if available, stethoscope.
Circulation: Umbilical catheterization tray, pre-flushed catheter, IO needle as backup, epinephrine in neonatal concentration, normal saline for volume expansion.
Intubation: Laryngoscope with working blade and light, endotracheal tubes in multiple sizes, stylet, tape or securing device, CO2 detector for confirming placement.

The person running this check does not need to be the most senior provider in the room. In fact, having a dedicated equipment person, sometimes called the “setup role,” frees the team leader to focus on clinical decision-making. Many units assign this role as part of a structured team briefing before the delivery, which research on quality improvement in the delivery room supports as a way to standardize care and reduce errors.

Preterm-Specific Additions

When a preterm delivery is anticipated, the checklist grows. Beyond the polyethylene wrap already mentioned, the team should have surfactant drawn up or readily available, smaller endotracheal tube sizes (as small as 2.5 mm for very preterm infants), and a blender set to a lower starting oxygen concentration. The T-piece resuscitator is particularly advantageous for preterm infants because of its ability to deliver consistent PEEP and controlled peak pressures. The meta-analysis discussed earlier found that flow-controlled devices like the T-piece were associated with lower rates of bronchopulmonary dysplasia in preterm populations, a condition that can lead to prolonged hospitalization and chronic lung problems.⁶

Temperature monitoring should be continuous for preterm infants, ideally with a skin probe connected to the radiant warmer’s servo-control system. A chemical warming mattress can be placed under the baby as an additional heat source. For infants expected to weigh under a kilogram, having an appropriately sized umbilical catheter and a weight-specific insertion depth reference is especially important, since standard formulas may not perform well at the extremes of birth weight.

Transport Readiness

Sometimes the resuscitation does not end in the delivery room. If the baby needs to move to a higher level of care, either within the same hospital or to another facility, a transport-ready setup should be part of the broader preparedness picture. Transport devices increasingly incorporate real-time monitoring of temperature, heart rate, and respiratory status to reduce risks like hypothermia and cardiovascular instability during the move. Having a portable ventilation device, a charged battery-powered monitor, and a pre-warmed transport incubator or cocoon-type warmer on standby when a high-risk delivery is anticipated prevents the scramble that often happens when a stable resuscitation suddenly needs to become a mobile one.

1
PubMed Central. Equipment preparedness for neonatal resuscitation in neonatal intensive care unit in resource limited setting: cross-sectional study
2
PubMed Central. Neonatal warming devices: What can be recommended for low-resource settings when skin-to-skin care is not feasible?
3
PubMed. Effective temperature under radiant infant warmer: does the device make a difference?
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PubMed. A comparison of three neonatal resuscitation devices
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The Journal of Pediatrics. Comparison of T-Piece Resuscitator and Self-Inflating Bag in Neonatal Resuscitation: A Randomized Controlled Trial
6
PubMed. Ventilation devices for neonatal resuscitation at birth: A systematic review and meta-analysis
7
PubMed Central. Endotracheal suctioning in intubated newborns: an integrative literature review
8
PubMed Central. Laryngeal Mask Airway in Neonatal Resuscitation: A Survey of the Union of European Neonatal and Perinatal Societies
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PubMed Central. Oxygen during Neonatal Resuscitation: Too Much versus Too Little, Does It Matter?
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Resuscitation Plus. Fast and accurate newborn heart rate monitoring at birth: A systematic review
11
PubMed Central. Newborn heart rate monitoring methods at birth and clinical outcomes: A systematic review
12
PubMed. Revised formula to determine the insertion length of umbilical vein catheters
13
PubMed Central. Comparative analysis of formulae for umbilical venous catheterization depth based on birth weight
14
Resuscitation Plus. First attempt success rate of intraosseous access in preterm infants and neonates: a systematic review
15
Resuscitation. Initial vascular access for neonatal resuscitation: a systematic review
16
PubMed Central. Use of eye-tracking to evaluate human factors in accessing neonatal resuscitation equipment and medications for advanced resuscitation: A simulation study
17
Human Factors in Healthcare. An intervention to improve the work system of neonatal resuscitation teams
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BMJ Journals. Comparing the utility of a novel neonatal resuscitation cart with a generic code cart using simulation: a randomised, controlled, crossover trial
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PubMed Central. Neonatal resuscitation in low-resource settings: What, who, and how to overcome challenges to scale up
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PubMed Central. Disinfection of Neonatal Resuscitation Equipment in Resource-Limited Settings: Lessons From a Mixed-Methods Implementation Experience in Kenya
21
PubMed Central. Disinfection of Neonatal Resuscitation Equipment in Low-Resource Settings: The Importance, the Reality, and Considerations for the Future