In 1966, Harold Abramson1 edited the first edition of the textbook “Resuscitation of the newborn infant”. Abramson was a professor of pediatrics at New York Medical College and chairman of the special committee on infant mortality. In his preface he describes neonatal resuscitation as a problem “as old as mankind, yet not satisfactorily solved”.1 Although he authored and edited many chapters, he admitted that “there is very little knowledge in neonatal resuscitation, due to a lack of understanding in the physiology of fetus and neonate, lack of techniques and reluctance to initiate studies. This has led to dogmatic practices, the acceptance of procedures not well founded and representation of unsubstantiated impressions and beliefs carried down through the years from textbook to textbook in scissor and glue pot fashion and from one practitioner to another”.1 Although some interventions are largely based on dogma, have been extrapolated from adult medicine, or are based on animal models with questionable relevance, they remain in resuscitation algorithms and recommendations from prominent resuscitation organizations like the International Liaison Committee on Resuscitation.2,3 While some 50 years have passed since Abramson’s textbook and our knowledge, although fragmentary, has increased, it is perhaps not a surprise that some of the interventions mentioned by Abramson’s remain in resuscitation treatment recommendations.

For many years the healthcare burden associated with neonatal medicine was underestimated and a “disconnect” between the scientific and clinical research meant that the continuous and ongoing need for improving care was largely fulfilled by clinical studies. However, the connection between scientific and clinical research has improved, which has increased awareness among clinicians as to the unique physiological challenges all infants must face to survive after birth. Indeed, infants at birth are unlike any other human patients, and when newborns cannot meet the physiological challenges required to transition to newborn life, clinicians need to intervene. However, the available equipment and interventions used in the delivery room lag far behind the resources and evidence-based practices that are available in the intensive care unit. This discrepancy is striking, given that postnatal transition represents a highly vulnerable period for newborn infants. This reflects a “gap in knowledge”, which likely results from the difficulties in conducting clinical studies in the delivery room, developing appropriate preclinical animal models to study fetal-to-neonatal transition and accurately replicating the scientific knowledge gained from preclinical models into clinical studies.4 In this commentary we will shortly discuss the considerable efforts that have been made to close this gap in knowledge, as well as the outstanding barriers to progress in neonatal resuscitation research.

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