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A Tale of Two Births:

One Minute Can Mean a Lifetime

The following are both true stories that were circulated widely in the media. Both involved emergencies in the first moments of a child’s life…

In the first story, the attending staff had trained aggressively to identify and manage labor and delivery emergencies. Upon diagnosing the immediacy of the risk factors present, the staff carried out a well-planned and rehearsed effort that avoided harm to the child. To the joy of the family, the birth was a resounding success.

At a nearby facility a similar emergency occurred, but a different story was playing out. How the circumstances were diagnosed and addressed led to emergency interventions that proved fatal to the child and resulted in a $10.2 million award to the mother.

Worldwide each year, an estimated 814,000 neonatal deaths are related to intrapartum hypoxic events (i.e. “birth asphyxia”) in full-term infants.Of those that survive, many are left with neurological impairments.2

When a baby is born, he or she should begin breathing within the “Golden Minute,” their first 60 seconds outside of the womb. Many babies do begin breathing on their own. 10 million babies worldwide, however, will need assistance.3 Approximately 10% of newborns who do not breathe on their own will respond to drying, warming, clearing of the airways, and stimulation. And, 1% of non-breathing babies will need advanced methods of resuscitation, such as chest compressions and medication.4

To the family, 1% means everything. That 1% stands in the way of the child’s survival, and increases the chance of brain damage even if he or she does survive. The mother who trusts that she will receive the best possible care expects that her providers have been fully prepared for the 1% risk.

One Minute: Too Short to Do Anything?

Someone once said that one minute is long enough to notice, but too short to do anything with.  “Too short” is dangerously false in labor and delivery.  The “Golden Minute” refers to the first 60 seconds of an infant’s life. Within these limited seconds, the infant should begin breathing on his or her own, or interventions must be started.

Approximately 4,000,000 babies are born each year in the United States.5 It is estimated that 400,000 of these babies will need help breathing and/or positive-pressure ventilations to successfully transition to extra-uterine life. And, as many as 12,000 infants will need advanced resuscitation with chest compressions and cardiac medications.6

In each case, steps taken to treat an infant must be precise and timely.

Nearly one half of newborn deaths occur during the first 24 hours after birth.7

Perinatal asphyxia and extreme prematurity are two pregnancy complications that can necessitate complex resuscitation. Only 60% of asphyxiated newborns can be predicted antepartum, however.8 The remaining newborns are not identified until the “Golden Minute,” which is why it is such a critical moment to prepare for.

Following delivery and cutting of the umbilical cord, initial assessment of the newborn should be viewed as a continuum that begins with routine care and may or may not progress to further resuscitation.

Scott Tomek, MA, EMT-P *

Why the Neonatal Resuscitation Program® (NRP®) Matters

Due to the frequent need for resuscitation at birth, it is critical to have evidence-based care guidelines and to train for effective neonatal resuscitation.

To ensure that healthcare providers remain up-to-date on advances in neonatal resuscitation, the American Heart Association (AHA) develops treatment guidelines every five years in the United States. The Neonatal Resuscitation Program® (NRP®), which is developed by the American Academy of Pediatrics (AAP), translates the AHA Guidelines into an educational curriculum.9

The curriculum developed by the AAP includes: eSim, skills practice, and an evaluation with simulation and debriefing. The combination of training methods help to prepare healthcare professionals to facilitate effective team-based care.

Anticipation, adequate preparation, accurate evaluation, and prompt initiation of support are critical for successful neonatal
resuscitation. 10

Some of the most common reasons for failed neonatal resuscitation include: 11

  • Failure to detect the need for resuscitation shortly after birth
  • Failure to have a qualified, experienced medical professional close by after a birth with heightened risk factors
  • Improper infant resuscitation techniques

The NRP® curriculum helps to increase a care team’s confidence and improve each member’s resuscitation and stabilization skills. Moreover, the curriculum specifically addresses communication and the decision-making processes that are essential in the first—and most important—60 seconds of a newborn’s life.

Recreating the Miracle of Birth

Recommended by the AAP in the NRP® curriculum, simulation plays a vital role in the learning transfer. Simulation reinforces skills practice, but more importantly, it introduces human factors to the scenario.

Team communications, interactions with the parents, and the inevitable feeling of uneasiness when a newborn is in distress can all be presented during a simulation. And, with simulation experience, the first time a care provider enters a high-risk, high-stress environment will not be with a real newborn. 

An important benefit of neonatal resuscitation simulation training is the prevention of medical error. Rather than emphasizing individual knowledge and skills, simulation training addresses preventable errors with continual systematic training, performance assessment, and refinement of practice as a team.13

One study found that in situ simulation training, taking place in a real clinical environment, helped to significantly decrease the number of hazardous events during a neonatal resuscitation.14 Another study found that nurses were almost 40% more likely to challenge an incorrect dosage of epinephrine following a simulation training.15

If you are wondering how to better prepare healthcare professionals for the “Golden Minute” and prevent medical errors resulting from human factors, simulation training can help. Following simulation training, care providers are likely to see an improvement in clinical decision-making, sharpened skills, and an increase in confidence as a team leader. Each of these competencies are critical during neonatal resuscitation.

A Happy Beginning

The birth of a baby is a beautiful moment and the “Golden Minute” can be, also. A skilled, confident, and cohesive care team can make all the difference in the first minute of a baby’s life. With formal and regular neonatal resuscitation training, healthcare professionals are better equipped to recognize newborn breathing difficulties, begin treatment within 60 seconds, and stabilize the infant.

One minute can determine a life.  It can also determine a lifetime.  In keeping with our mission of helping save lives, Laerdal is committed to helping you provide the training that can prepare practitioners to manage every second of that minute.  We want to help you ensure that every birth you touch, directly or indirectly, is a happy beginning.


  1. Imdad, A., Yakoob, M.Y., Siddiqui, S., & Bhutta, Z.A. (2011). Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: A systematic review with a focus on reduction of IUGR related stillbirths. BMC Public Health, 11(3). DOI:
  2. My Child. (2017). Hypoxic-ischemic encephalopathy, or HIE, also known as intrapartum asphyxia. Retrieved from:
  3. Heerden, V. (2012). An introduction to helping babies breathe: The golden minute is here for south African newborn babies. Professional Nursing Today, 16(3).
  4. Ibid
  5. American Heart Association. (2005). Neonatal resuscitation guidelines. American Heart Association, 112(24). DOI: 
  6. Ibid
  7. Bissinger, R.L. (2015). Neonatal resuscitation. Medscape. Retrieved from:
  8. Ibid
  9. Umoren, S.T. (2016). Neonatal resuscitation: Advances in training and practice. Advances in Medical Education and Practice, 8, 11-19. DOI:
  10. American Heart Association. (2005). See reference #4.
  11. Birth Injury Guide. (2017). Infant Resuscitation Errors. Birth Injury Guide. Retrieved from:
  12. Stokowski, L.A. (2006). Simulation training in neonatal resuscitation: Practice makes perfect. Medscape. Retrieved from:
  13. Ibid
  14. Rubio-Gurung, S., Putet, G., Touzet, S., Gauthier-Moulinier, H., Jordan, I., Beissel, A., et al. (2014). In situ simulation training for neonatal resuscitation: An RCT. Pediatrics, 134(3), 790-797. DOI: 10.1542/peds.2013-3988
  15. Sawyer, T., Laubach, V., Yamamura, K., Hudak, J., Pocrnich, A. (2013). Interprofessional teamwork training in neonatal resuscitation using TeamSTEPPS and event-based approach simulation. Association of American Medical Colleges. Retrieved from:
  16. Halamek, L.P., Kaeji, D.M., Gaba, D.M., Sowb, Y.A., Smith, B.C., Smith, B.E., et al. (2000). Time for a new paradigm in pediatric medical education: Teaching neonatal resuscitation in a simulated delivery room environment. Pediatrics, 106(45).

*Tomek, S. (2011). Newborn resuscitation: The golden minute. EMS World. Retrieved from: