Background: Up to 10 % of all newborns require assistance to breathe at birth. Although neonatal resuscitation guidelines and educational platforms exist, best practices to implement high-quality neonatal resuscitation care have not been defined. Aim: To establish a Neonatal Global Resuscitation Alliance and develop ten steps to improve outcomes of in-facility neonatal resuscitation across global settings. Methods: Three-stage iterative consensus-based process: (1) invited input from the neonatal resuscitation community to identify pertinent measures, (2) convened a face-to-face meeting of 28 global neonatal resuscitation content experts to refine consensus steps, (3) presented draft steps and related content to stakeholders; solicited public comment and revised ten steps based on feedback. Results: The consensus-based ten steps include: Implement effective education systems; Ensure team and equipment readiness; Identify high-risk pregnancies and prevent perinatal risks; Respond to every birth; Perform guideline based resuscitation; Deliver guideline based post-resuscitation care; Collect data throughout resuscitation care; Improve quality of resuscitation; Support parent and family well-being; Cultivate a culture of excellence. For each of these steps, key concepts and suggested approaches to put the steps into practice are identified. Conclusion: These ten steps to improve outcomes of in-facility neonatal resuscitation represent a clear framework for healthcare professionals, institutions, and policymakers to evaluate and strengthen their readiness, training, and response to newborns who need resuscitation at birth. This consensus-based guidance can be used to optimize in-facility neonatal resuscitation and improve outcomes for newborns worldwide.