Adequate ventilation is the key to successful neonatal resuscitation (ILCOR 1999; ILCOR 2000). The Neonatal Subcommittee of the International Liaison Committee on Resuscitation (ILCOR) have produced consensus statements on neonatal resuscitation which advise that infants who have absent or inadequate respiratory efforts and or bradycardia should receive positive pressure ventilation (ILCOR 1999; ILCOR 2000). Use of a manual ventilation device with a face mask is advised, though it is noted that ventilation via an endotracheal tube may be indicated at several points during neonatal resuscitation. The types of manual ventilation devices described are the self‐inflating bag and the flow‐inflating (or anaesthetic) bag. The T‐piece device is mentioned in a list of suggested equipment but not described further.

Self‐inflating bags automatically re‐expand after compression due to their own elastic recoil. While a compressed gas source is not required for these bags to function, oxygen and a reservoir are normally attached to facilitate the delivery of high concentration of oxygen in the inspired gas. The maximum peak inspiratory pressure that can be delivered is limited by a pressure‐release or "pop‐off" valve. Self‐inflating bags do not themselves provide PEEP, though a PEEP valve may be fitted to certain models. The most commonly used self‐inflating bag, the Laerdal Infant Resuscitator (O'Donnell 2004a; O'Donnell 2004b), is of insufficient size to sustain an inflation greater than 1 second (ILCOR 2000).

Flow‐inflating bags depend on a compressed gas source to inflate the bag during use. These devices, which should only be used with a manometer in the circuit (ILCOR 1999; ILCOR 2000), allow for the application of a greater range of PIP. They may also be used to provide a positive end‐expiratory pressure (PEEP) by means of controlling rate of gas escape at the outlet from the bag. Inflations of greater than one second may be delivered with flow‐inflating bags.

T‐pieces also require a compressed gas source to function. The gas flows into a face mask or ETT through an 'inlet' arm and inflation is achieved by interrupting the escape of gas through the outlet. The PIP is usually monitored with a manometer and a safety blow‐off valve is usually included in the circuit. PEEP may be delivered by controlling the rate of gas escape from the outlet. The length of inflation is determined by the duration of occlusion of the outlet and may easily exceed one second.

While not described in ILCOR guidelines, respiratory support of infants in the delivery room using a mechanical ventilator (as opposed to a manual ventilation device) and nasopharyngeal tube (as opposed to a face mask or endotracheal tube) has been described (Lindner 1999).

At birth infants' lungs are filled with fluid which must be cleared for effective respiration to occur. Most newly born infants achieve this spontaneously and may use considerable negative pressures (up to ‐50cmH2O) for initial inspirations (Karlberg 1962; Milner 1977). However, it is estimated that 3‐5% of newly born infants receive some help to breathe at delivery (Saugstad 1998). In a study of 20 term infants delivered by Caesarean section under general anaesthesia resuscitated via an endotracheal tube, it was noted from respiratory traces obtained that gas continued to enter the lung at the end of a standard 1 second inflation (Boon 1979). Based on this observation, a non‐randomised study of the resuscitation of nine term infants in the delivery room using a T‐piece device via an endotracheal tube was performed. It showed that an initial five second inflation with a T‐piece produced a two‐fold increase in inflation volume compared to standard resuscitation techniques and always led to the formation of a functional residual capacity (Vyas 1981). Citing these studies, a report described the effects of a change in management strategy of extremely low birth weight infants in the delivery room (Lindner 1999). The new management strategy included the introduction of an intial sustained inflation of 15 seconds with a mechanical ventilator via a nasopharyngeal tube. This change in strategy resulted in a reduction in the proportion of infants intubated for ongoing respiratory support without apparent increases in adverse outcomes.

ILCOR note that some experts suggest very long inflation times (two to three seconds) for initial inflations, but state this has not been accepted for universal recommendation (ILCOR 1999; ILCOR 2000).