The AAP released the 9th edition of the Neonatal Resuscitation Program in November 2025. NRP Instructors must begin using the 9th edition materials before June 1, 2026. The updated textbook and materials are now available for purchase from the AAP Store.

Here are some links that may be helpful to navigate the changes:

• NRP Home Page
• AAP NRP Update Page
• NRP 9^th Edition Science Changes (Summary Table)
• Webinar: What’s New in the NRP 9^th Edition

Key Changes in the 9^th Edition:

Umbilical Cord Management:

• “Initiate cord management plan” has been added as the first step after birth on the NRP algorithm. This addition serves as a visual reminder to those going through the algorithm and emphasizes the importance of delayed cord clamping for most newborns.
• The recommended duration of deferred cord clamping has been increased to “at least 60 seconds” for most newborns, with specific guidelines for preterm infants and more information on cord milking.

Ventilation:

• The MR SOPA ventilation corrective steps are more flexible (not strictly sequential)
• The laryngeal mask airway may now be used as a primary device, rather than only as an alternative to endotracheal intubation.
• When providing assisted ventilation, the recommended initial setting for Peak Inflation Pressure (PIP) for newborns >= 32 weeks has increased to 25 cm H₂O. The recommended initial setting for PEEP (positive end-expiratory pressure) is still 5 cm H₂O
• The recommended rate of assisted ventilations has updated to 30-60 breaths per minute
• Endotracheal tube insertion depth has been changed to “tip-to-gum” (versus the previously recommended “tip-to-lip”), where the insertion depth is marked at the anterior edge of the baby’s upper gum at the midline. The recommended insertion depth is based on the baby’s gestational age and/or weight

Oxygen Targeting:

• Oxygen saturation targets now start at 2 minutes (65-70%) instead of 1 minute, reflecting practical timing.
• The recommended initial oxygen concentration (FiO2) remains at 21% for infants ≥35weeks gestation. The recommended initial FiO₂ for infants 32-34 weeks gestation is a range of 21%-30%. For infants <32 weeks gestation, it is recommended to use an initial FiO₂ ≥30%.

New Learning Modules:

• Lesson 15: Resuscitation and Stabilization of Newborn Infants with Congenital Heart Disease
• Lesson 16: Resuscitation in the NICU

The science upon which the NRP recommendations are based was published in October 2025:

Liley, H. et al., on behalf of the Neonatal Life Support Task Force, Neonatal Life Support: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations. Pediatrics 2025; 10.1542/peds.2025-074766

Lee, H. et al., Part 5: Neonatal Resuscitation: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 2025; 10.1542/peds.2025-074352