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

Background: Neonatal resuscitation guidelines are periodically updated to reflect advances in evidence and clinical practice. In October 2025, the American Heart Association-American Academy of Pediatrics (AHA-AAP) and the European Resuscitation Council (ERC) released updated neonatal resuscitation guidelines, both based on the scientific evaluations of the International Liaison Committee on Resuscitation (ILCOR). Despite this shared foundation, relevant differences remain between the two documents in terms of scope, structure, and specific clinical recommendations. Summary: We reviewed the documents, identified several areas of divergence, and reached a qualitative consensus about their clinical importance. This narrative review compares the 2025 AHA-AAP and ERC guidelines, focusing on algorithm design, initial stabilization, ventilation strategies, and oxygen administration. Both guidelines promote a gentle, physiology-based approach to neonatal transition and emphasize family-centered care. However, they diverge in several areas, including the complexity of resuscitation algorithms, the management of ventilation, and recommendations for initial inspired oxygen concentration. Many of these differences reflect variations in the scope of the documents rather than conflicting interpretations of evidence. Key messages: Several recommendations continue to rely on limited data and reflect a consensus of expert opinion. Persistent gaps in knowledge underscore the need for further high-quality research to inform future updates and support greater harmonization of neonatal resuscitation practices.