Approximately 85,000 neonates require delivery room resuscitation for birth asphyxia each year. Skillful, rapid interventions along with anticipation and preparation are needed to prevent adverse outcomes. The American Academy of Pediatrics and American Heart Association have developed a certification program for personnel functioning in this role. The components of resuscitation are initial steps, bag and mask ventilation, chest compressions, endotracheal intubation, and medications. Meconium staining, congenital malformations, and the very low birth weight infant present special challenges for the asphyxiated neonate. Once resuscitated, the neonate must be stabilized and evaluated for level of care needs.