NB-01: In newborn dogs and cats that require resuscitation (with or without CPA) (P), how does initiating PPV at any other heart rate target (I), compared with HR less than 100 bpm (C) improve outcome (O)?

• We recommend initiating PPV in non-vigorous newborn dogs and cats with cleared upper airways that are bradycardic. (strong recommendation, expert opinion)
• We suggest using a heart rate below 120 beats/minute as the threshold for initiating PPV in non-vigorous newborn dogs and cats with cleared upper airways. (weak recommendation, expert opinion)
• We recommend starting PPV as early as possible in non-vigorous dogs and cats that are gasping or are apneic, regardless of the heart rate. (strong recommendation, expert opinion)

NB-02: In newborn dogs and cats that require resuscitation in which PPV has been initiated (P), how does starting chest compressions below any other heart rate (I), compared with less than 60 bpm (C) improve outcome (O)?

• In severely bradycardic newborn dogs and cats that have received effective PPV and oxygen supplementation for at least 30 seconds, we recommend initiating chest compressions. (strong recommendation, expert opinion)
• We suggest using a heart rate below 50 beats/minute as the threshold for initiating chest compressions in newborn dogs and cats that have received effective PPV and oxygen supplementation for at least 30 seconds. (weak recommendation, expert opinion)

NB-03: In newborn dogs and cats that require resuscitation with PPV (P), how does any other concentration of inspired oxygen (I), compared with 100% oxygen (C) improve outcome (O).

• We suggest the use of room air (21% oxygen) over 100% oxygen during early assisted ventilation of newborn dogs and cats. (weak recommendation, very low quality of evidence)
• We suggest the use of 100% oxygen in newborn dogs or cats in which the HR fails to increase despite 1-2 minutes of PPV. (weak recommendation, expert opinion)

NB-04: In newborn dogs and cats without CPA that require resuscitation (P), how does the use of electrocardiography (ECG) (I), compared with any other heart rate assessment (e.g., pulse oximetry, apex beat palpation, auscultation) (C), improve outcome (O)?

• In newborn dogs and cats requiring resuscitation, we suggest estimating the HR using any of the following techniques: apex beat palpation, cardiac auscultation, ECG, Doppler ultrasound probe applied to the thorax.(weak recommendation, very low quality of evidence)
• In newborn dogs and cats requiring resuscitation, we suggest against the use of pulse oximetry as the only method to evaluate HR. (weak recommendation, very low quality of evidence)

NB-05: In newborn dogs and cats without CPA that require resuscitation and with the need for intermittent PPV (P), how does ventilation via endotracheal intubation (I), compared with using a tight-fitting face mask (C), improve outcome (O)?

• In newborn dogs and cats without CPA that require PPV, we suggest use of a tight-fitting facemask attached to a self-inflating resuscitator (i.e., “bag”) to deliver positive pressure breaths within 60 seconds of birth. (weak recommendation, very low quality of evidence)
• In newborn dogs and cats without CPA undergoing PPV by facemask and that fail to respond within 60 seconds (e.g., HR remains < 120 bpm despite intervention), we suggest endotracheal intubation for continued PPV if feasible. (weak recommendation, expert opinion)

NB-06: In newborn dogs and cats that require resuscitation with PPV (P), how does administration of longer inspiratory times, higher inflation pressures and PEEP (I), compared with an inspiratory time of 1 second and a peak inspiratory pressure of 20 cm H2O and no PEEP (C) improve outcome (O)?

• In newborn dogs and cats that require resuscitation with PPV, we suggest administering PPV with an inspiratory time of 1 second and a peak inspiratory pressure of 20 - 25 cm H2O. (weak recommendation, very low quality of evidence)
• In newborn dogs and cats that require resuscitation with PPV, we suggest application of at least 4 and no more than 8 cm H2O positive end-expiratory pressure. (weak recommendation, very low quality of evidence).
• In newborn dogs and cats with bradycardia, cyanosis, or inadequate breathing efforts that persist despite 30 – 60 seconds of standard PPV using 1 second inspiratory time at a peak inspiratory presure of 20 – 25 cm H2O, we suggest giving a single 30-second sustained inflation at 30 – 35 cm H2O followed by continued standard PPV if indicated. (weak recommendation, low quality of evidence).

NB-07: In newborn dogs and cats that do not demonstrate adequate spontaneous ventilation efforts at birth (P), how does administration of doxapram (I), compared with no administration of doxapram (C), improve outcome (O)?

• We recommend against the routine administration of doxapram in newborn puppies and kittens undergoing resuscitation. (strong recommendation, moderate quality of evidence)
• In apneic or gasping newborn puppies and kittens that are not responding to PPV, we suggest doxapram administration. (weak recommendation, very low quality of evidence).
• In newborn puppies and kittens that are bradypneic and that fail to respond to timely administration of other supportive measures, we suggest the use of doxapram. (weak recommendation, very low quality of evidence)

NB-08: In newborn dogs and cats that do not demonstrate adequate spontaneous ventilation efforts at birth (P), how does no needle stimulation (I), compared with insertion of a needle in the nasal philtrum (GV26) (C), improve outcome (O)?

• We did not reach consensus on whether to suggest for or against GV26 stimulation in newborn puppies and kittens with inadequate spontaneous ventilation at birth.

NB-09: In newborn dogs and cats that require resuscitation at birth (P), how does clearance of the upper airway by suctioning (I), compared with no clearance (C), improve outcome (O)?

• For newborn dogs and cats that require resuscitation at birth but that are vigorous, we suggest using a clean, dry cloth to carefully remove fluid from around the nostrils and mouth. (weak recommendation, expert opinion)
• For newborn dogs and cats that are non-vigorous with excessive oropharyngeal fluid (clear or meconium-stained), we suggest gentle nasal or oropharyngeal suctioning immediately followed by PPV. (weak recommendation, expert opinion)
• For newborn dogs and cats that are non-vigorous with excessive oropharyngeal fluid (clear or meconium-stained), we suggest against the routine use of endotracheal suctioning. (weak recommendation, very low quality of evidence)

NB-10: In newborn dogs and cats that require resuscitation at birth (P), does clearance of the upper airway by any other method (I), compared with airway clearance with suctioning (C), improve outcome (O)?

• We suggest against interventions other than suctioning to clear excessive upper airway fluid in newborns. (weak recommendation, expert opinion)
• We recommend against removal of upper airway fluid in newborn dogs and cats by swinging. (strong recommendation, expert opinion)

NB-11: In newborn dogs and cats that require resuscitation at birth (P), how does no temperature control (I), compared with maintenance of normothermia (95° to 99° F [35° to 37.2° C]) (C), improve outcome (O)?

• In newborn dogs and cats that require resuscitation, we recommend maintenance of normothermia compared to no temperature control. (strong recommendation, moderate quality of evidence)

NB-12: In newborn dogs and cats with cardiopulmonary arrest (P), how does any other specific rate for external chest compressions (I), compared with a compression rate of 120/minute (C), improve outcome (O)?

• We suggest delivering chest compressions in newborn dogs or cats at 120 to 150 compressions per minute. (weak recommendation, very low quality of evidence)

NB-13: In newborn dogs and cats receiving chest compressions (P), how does other compression to ventilation ratios (e.g., 30:2; 15:2, 9:3, 5:1) (I), compared with a compression:ventilation ratio of 3:1 (C), improve outcome (O)?

• In newborn puppies and kittens receiving chest compressions and PPV, we suggest a C:V ratio of 4:1. (weak recommendation, expert opinion)

NB-14: In newborn dogs and cats receiving chest compressions and PPV via endotracheal tube (P), how does pausing chest compression to administer breaths (I) compared with simultaneous ventilations and chest compressions (C), improve outcome (O)?

• In newborn dogs and cats receiving chest compressions and PPV with a cuffed endotracheal tube in place, we suggest delivering breaths concurrently to chest compressions (asynchronized ventilation). (weak recommendation, very low quality of evidence).
• In newborn dogs and cats receiving chest compressions and PPV that are not intubated with a cuffed endotracheal tube, we recommend synchronized ventilation by pausing chest compressions to deliver breaths. (strong recommendation, expert opinion)

NB-15: In newborn dogs and cats that require resuscitation (P), how does the use of no external physical stimulation (I), compared with tactile stimulation (e.g., rubbing) (C), improve outcome (O)?

• In newborn dogs and cats that require resuscitation, we recommend the use of tactile stimulation (e.g., rubbing, drying) immediately after birth without delaying essential interventions such as PPV (strong recommendation, very low quality of evidence).

NB-16: In newborn dogs and cats receiving chest compressions (P), how does the administration of ventro-dorsal chest compressions (i.e., over the sternum) (I) compared with lateral chest compressions (C), improve outcome (O)?

• In newborn dogs and cats requiring chest compressions, we suggest application of chest compressions in the latero-lateral direction. (weak recommendation, expert opinion).
• In newborn dogs and cats requiring chest compressions, we suggest ventrodorsal (sternal) chest compressions when additional resuscitation measures (e.g., umbilical cord cannulation, monitoring modalities) are facilitated by dorsal recumbency. (weak recommendation, expert opinion).
• In newborn dogs and cats requiring chest compressions in lateral recumbency, we recommend that 1-2 fingers are located over the heart to compress the chest toward the tabletop, or alternatively, that 1-2 fingers (index and middle finger) and opposing thumb are used to compress the chest directly over the heart. (strong recommendation, expert opinion)
• In newborn dogs and cats requiring chest compressions in which dorsal recumbency is preferred (e.g., for cannulation of the umbilical vein or pronounced wide-chested thorax conformation), we recommend that 1 – 2 fingers (index and middle finger) compress the sternum toward the tabletop to achieve the targeted chest compression depth. (strong recommendation, expert opinion)

NB-17: In newborn dogs and cats receiving chest compressions (P), how does another chest compression depth (I) compared with 1/3 of chest width (C), improve outcome (O)?

• In newborn dogs and cats receiving chest compressions, we suggest a compression depth of 1/3-1/2 the width of the chest for latero-lateral compressions. (weak recommendation, very low quality of evidence)
• In newborn dogs and cats receiving chest compressions, we suggest a compression depth of 1/3 the anterior-posterior (AP) diameter of the chest for ventrodorsal (i.e., sternal) compressions. (weak recommendation, very low quality of evidence)

NB-18: In newborn dogs and cats receiving chest compressions (P), how does ventilation with any other oxygen concentration (I), compared with 100% oxygen (C), improve outcome (O)?

• In newborn dogs and cats receiving chest compressions, we suggest PPV with 100% oxygen. (weak recommendation, very low quality of evidence)

NB-19: In newborn dogs and cats that require resuscitation (with or without CPA) (P), how does routine parenteral administration of dextrose (I), compared with targeted administration of dextrose (C), change outcome (O)?

• In newborn dogs and cats that require prolonged resuscitation, we suggest measuring a blood glucose concentration. (weak recommendation, expert opinion)
• In newborn dogs and cats that require resuscitation (with or without CPA) and have documented hypoglycemia, we recommend dextrose supplementation with a slow bolus of 0.25 g/kg dextrose (e.g., 1 mL/100 g of 2.5% dextrose in isotonic crystalloid solution over 5 minutes) IV, IO or IP. (strong recommendation, very low quality of evidence)
• In hypoglycemic newborn puppies and kittens in which IV/IO or IP access are not possible, we suggest topical sublingual mucosal administration of dextrose at 0.5 g/kg (e.g., 0.1mL of 50% dextrose per 100 g body weight). (weak recommendation, expert opinion)
• In newborn puppies and kittens undergoing prolonged resuscitation (e.g., > 10 minutes) that are not responding to standard measures (e.g., PPV, rewarming, stimulation) and in which BG concentrations cannot be measured, we suggest dextrose supplementation. (weak recommendation, expert opinion)

NB-20: In newborn dogs and cats that require resuscitation after Caesarian birth (with or without CPA) (P), how does no administration of antagonists to sedatives given to the dam (e.g., naloxone) (I) compared with parenteral administration of antagonists (C) improve outcome (O)?

• In newborn dogs and cats that require resuscitation after a C-section for which the dam was administered an opioid, α2-adrenoceptor agonist, or benzodiazepine, we recommend administration of the appropriate reversal drug. (strong recommendation, very low quality of evidence)
• In newborn dogs and cats that are vigorous at birth and in which the dam was administered an opioid, α2-adrenoceptor agonist, or benzodiazepine, there is insufficient evidence to suggest for or against routine administration of reversal drugs. (weak recommendation, very low quality of evidence)

NB-21: In newborn dogs and cats with very low heart rate (e.g., HR < 50 bpm) despite adequate PPV and chest compressions (P), how does routine parenteral administration of no epinephrine (I), compared with epinephrine administration (C), improve outcome (O)?

• In newborn puppies and kittens with very low heart rate (i.e., HR < 50 beats/min) despite 60 seconds of adequate PPV and chest compressions, we recommend administration of epinephrine. (strong recommendation, moderate quality of evidence)
• In newborn dogs and cats with very low heart rate (i.e., HR < 50 bpm) despite 60 seconds of adequate PPV and chest compressions, we recommend IV or intraosseous (IO) administration of epinephrine over intratracheal or intranasal administration. (strong recommendation, moderate quality of evidence)
• In newborn dogs and cats with very low heart rate (i.e., HR < 50 bpm) despite adequate PPV and chest compressions, we suggest against IM administration of epinephrine (including intralingual IM administration). (weak recommendation, very low quality of evidence)

NB-22: In newborn dogs and cats with a very low heart rate (e.g., HR < 50 bpm) despite adequate PPV and chest compressions (P), how does a different dose of IV/IO epinephrine (I), compared with 0.01 mg/kg IV/IO (C), improve outcome (O)?

• In newborn cats and dogs that remain severely bradycardic (i.e., < 50 bpm) despite 60 seconds of PPV and chest compressions, we recommend 0.01 – 0.03 mg/kg epinephrine IV / IO (strong recommendation, very low quality of evidence).
• In newborn cats and dogs that remain severely bradycardic (i.e., < 50 bpm) despite 60 seconds of PPV and chest compressions, we recommend against high dose (0.1 mg/kg) IV / IO epinephrine (strong recommendation, very low quality of evidence).
• In newborn cats and dogs that remain severely bradycardic (i.e., < 50 bpm) despite 60 seconds of PPV and chest compressions, in which epinephrine is given endotracheally because IV / IO access is impossible or significantly delayed, we suggest 0.05 – 0.1 mg/kg epinephrine ET (weak recommendation, very low quality of evidence).

NB-23: In newborn dogs and cats that require resuscitation and are bradycardic (P), how does routine parenteral administration of atropine (I), compared with no atropine administration (C), improve outcome (O)?

• In newborn dogs and cats that require resuscitation and are bradycardic, we suggest against routine atropine administration.(weak recommendation, expert opinion)

NB-24: In newborn dogs and cats that require resuscitation that are in CPA (P), how does routine parenteral administration of atropine (I), compared with no atropine administration (C), improve outcome (O)?

• In newborn dogs and cats that require resuscitation that are in CPA, we suggest against the routine administration of atropine during CPR.(weak recommendation, expert opinion)

NB-25: In newborn dogs and cats receiving chest compressions (P), how does continuation of well executed chest compressions beyond 10 minutes (I) compared with discontinuation of chest compressions after 10 minutes (C) improve outcome (O)?

• In newborn dogs and cats receiving chest compressions, we suggest continuation of CPR for at least 15 minutes before abandoning resuscitation efforts, as long as such efforts do not detract from necessary care of littermates with a better prognosis.(weak recommendation, very low quality of evidence)

NB-26: In newborn dogs and cats after ROSC (P), how does routine parenteral administration of glucose (I), compared with targeted administration of glucose (C), improve outcome (O)?

• In newborn puppies and kittens that are non-vigorous and not nursing, we suggest measuring a blood glucose concentration.(weak recommendation, expert opinion)
• In hypoglycemic newborn puppies and kittens after ROSC, we suggest supplementing dextrose by continuous rate infusion (e.g., 2.5% dextrose in isotonic crystalloid fluids given at a physiologic rate IV or IO) rather than by bolus injection. (weak recommendation, very low quality of evidence)
• In newborn puppies and kittens after ROSC that have documented hypoglycemia, we recommend dextrose supplementation with a slow bolus of 0.25 g/kg dextrose (e.g., 1 mL /100 g of 2.5% dextrose over 5 minutes) IV, IO or IP, if an IV or IO CRI is not feasible. (strong recommendation, very low quality of evidence)
• In hypoglycemic newborn puppies and kittens after ROSC in which IV, IO or IP administrations are not possible, we suggest oral administration of dextrose at 0.5 g/kg (e.g., 0.1 mL of 50% dextrose per 100 g body weight). (weak recommendation, expert opinion)
• In newborn puppies and kittens that are non-vigorous and not nursing after resuscitation and in which blood glucose concentrations cannot be measured, we suggest dextrose supplementation. (weak recommendation, expert opinion)

NB-27: In newborn dogs and cats with ROSC that remain comatose (P), how does permissive hypothermia to maintain core temperature below normal (I), compared with active warming to maintain or achieve normothermia (C), improve outcome (O)?

• In newborn dogs and cats with signs of acute hypoxic-ischemic encephalopathy, we suggest permitting the animal to remain at a low normal temperature for newborn puppies and kittens (i.e., 35°C, 95°F) for 24 hours after birth (weak recommendation, expert opinion).

NB-28: In newborn dogs and cats with ROSC that are spontaneously hypothermic (P), how does rewarming at a rate greater than 1°C/hour (I) compared with rewarming at a rate of 1 or less °C/hour (C) improve outcome (O)?

• In newborn puppies and kittens that are hypothermic at birth and show evidence of hypoxic-ischemic injury, we suggest rewarming at a rate no faster than 1°C/h to achieve normothermia (35.0-37.2°C; 95-99°F) while avoiding accidental hyperthermia. (weak recommendation, very low quality of evidence)
• In newborn puppies and kittens that are hypothermic at birth without signs of hypoxic-ischemic encephalopathy, we suggest to actively rewarm newborns over 1-2 hours to reach normothermia (35.0–37.2°C; 95-99°F), avoiding accidental hyperthermia. (weak recommendation, expert opinion)