In 2015, both the European Resuscitation Council and the American Heart Association neonatal resuscitation guidelines recommended delayed cord clamping (DCC) for term and preterm neonates. This change in practice produced a gap in knowledge regarding normative neonatal heart rate (HR) during the extrauterine transition with an intact cord. In this issue, Rettedal et al’s study of 4876 neonates with HR measured by dry electrode ECG presents informative data on HR in the first minute after birth with an intact cord.1 In their study of neonates ≥28 weeks gestation, the median time to cord clamping was 301 s (quartiles 222, 396 s) after birth, and the median time of the first registered HR was 16 s (quartiles 11, 28 s) after birth. In this population, 16.3% of neonates had a first measured HR <100 beats per minute (bpm). Furthermore, 25% of neonates had a registered HR <100 bpm at some point during the first minute after birth. HR among neonates who were initially bradycardic nearly always increased, with only 6.3% of neonates having an HR <100 bpm by 30 s after birth, and only 3.7% by 60 s. Surprisingly, only 18% of neonates with HR <100 bpm at 60 s after birth received positive pressure ventilation (PPV).

Current neonatal resuscitation guidelines state that PPV is indicated either for inadequate breathing (apnoea …