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Resuscitation · NRP

PPV Initial Settings

Starting values for positive-pressure ventilation of the newborn — PIP, PEEP, rate and FiO₂ — per the NRP 9th Edition algorithm.

Gestational age

PIP (starting)
20–25cm H₂O
Term may need 30–40 for the first few breaths.
PEEP
5cm H₂O
Continuous throughout PPV.
Rate
40–60/min
"Breathe – two – three – breathe – two – three."
Starting FiO₂
21%
Room air. Titrate to preductal SpO₂ target.

If chest is not moving after 15 seconds of PPV

  1. MR SOPA corrective steps in order:
    • Mask adjustment
    • Reposition airway (sniffing)
    • Suction mouth then nose
    • Open the mouth slightly
    • Pressure increase (↑ PIP in 5 cm H₂O steps, max ~40)
    • Airway alternative (LMA or ETT)
  2. Reassess chest rise and heart rate after each pair (MR, then SO, then PA).

FiO₂ escalation

Below SpO₂ target↑ FiO₂ in 10% steps
Above SpO₂ target↓ FiO₂ in 10% steps
Chest compressions started100% FiO₂
HR > 100 & target reachedWean FiO₂

See preductal SpO₂ targets by minute of life →

How to adjust these settings once PPV starts, and what the heart rate response means: NRP PPV settings guide.

Clinical decision support only. Starting values per NRP 9th Edition. Titrate to chest rise, heart rate response and preductal SpO₂. Follow your institutional protocols. Designed and written by C. A. Leyva, MD — a certified neonatologist and NRP provider. PediaSuite is an independent study aid and is not affiliated with the AAP or AHA.

Reviewed by C. A. Leyva, MD, neonatologist · Last reviewed September 2026

References

  1. American Academy of Pediatrics, American Heart Association. Textbook of Neonatal Resuscitation. 9th ed. Itasca, IL: American Academy of Pediatrics; 2025. Lesson 4: Ventilation, Table 4-2.
  2. Lee HC, Strand ML, Finan E, et al. Part 5: Neonatal Resuscitation: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16 Suppl 2):S385–S423. doi:10.1161/CIR.0000000000001367
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