Abstract: Objective To analyze related risk factors in resuscitation difficulty in neonates. Methods Live birth asphyxia neonates with gestational age≥28 weeks (1 minute Apgar score count of 0-7) were included during January 2011 to October 2015. After resuscitation, the neonates were divided into two groups by 5 minutes Apgar score, successful resuscitation group (Apgar score of 8-10) and poor resuscitation group (Apgar score of 0-7). The analysis of related risk factors was performed. Neonates with poor resuscitation assessed by 5 minutes Apgar were continued being resuscitated. After 20 minutes, these neonates were divided into successful resuscitation group (20 minutes Apgar 8-10) and poor resuscitation group (20 minutes Apgar 0-7). The related risk factors analysis was performed once again. Results A total of 743 neonates with asphyxia at one minute were included, among whom 130 cases were poor resuscitation and 613 cases were successful resuscitation at 5 minutes. There were obvious correlations of 5 minutes poor resuscitation with premature delivery, low birth weight, 1 minute Apgar score for 0 ~ 3, intrapartum infectious fever, abnormal placenta, vaginal bleeding during late pregnancy, twin transfusion syndrome, and fetal malformation (P all < 0.05). Neonates with 5 minutes poor resuscitation continued being resuscitated, 32 cases were still poor resuscitation at 20 minutes, and compared with 98 cases of successful resuscitation, there were statistical differences in 1 minute and 5 minutes Apgar score of 0 ~ 3 (P all < 0.05). Two cases of vasa praevia and eight cases of fetal edema neonates were still poor resuscitation at 5 minutes and 20 minutes who were asphyxia at one minute. Conclusion There are many factors affecting the resuscitation of asphyxia neonates, among which vasa praevia and fetal edema are most adverse factor in neonatal resuscitation difficulty.