Preamble

Everything you know about adult resuscitation arrives at the newborn's side slightly wrong. In the adult we assume the heart failed first, and the algorithm reflects it: compressions early, defibrillator, adrenaline, and ventilation somewhere behind. In the newborn the sequence is almost always inverted. The lungs are fluid-filled and have never been inflated, or have stopped being inflated. Hypoxia follows. Bradycardia follows that, because a newborn's cardiac output is rate-dependent and there is no stroke volume to recruit. Asystole is the end of the story, not the beginning.

Which makes the intervention that matters unglamorous. Not the drug, not the compressions — the inflation of the lungs. A rising heart rate after effective ventilation is the whole of the evidence that you are succeeding, and if it is not rising the answer is almost never more adrenaline. It is that the lungs are not being inflated, and MR SOPA exists because the reasons are enumerable.

The word generally is doing real work. Congenital heart disease, a duct that has closed, hyperkalaemia, a pneumothorax under tension — these are primary circulatory catastrophes, and they will not respond to a better mask seal.

Do you agree?  Yes / No / Maybe