BACKGROUND: Each year, millions of neonates require supportive interventions in the delivery room (DR) during the transition from intrauterine to extrauterine life. Resuscitation guidelines are critical for healthcare providers managing these neonates and rely on current evidence of real-world DR management. However, data on the actual frequency of various supportive interventions are often limited, focused on single centers or outdated. This study aims to describe the current practice of neonatal resuscitation and support in the DR and to provide evidence for the development of clinical guidelines. METHODS: This prospective, international, multicenter observational study collected data from 68 hospitals in 19 countries over a 6-month period. Pre-defined supportive interventions administered to neonates of all gestational ages within the first 30 min of life were recorded. Additionally, structural hospital characteristics and patient characteristics of supported neonates were documented. RESULTS: Approximately 11.1% of the 74,183 neonates born during the observation period received relevant supportive interventions. The most common interventions were continuous positive airway pressure (CPAP), oxygen supplementation, and suctioning. Less common interventions included epinephrine administration, intraosseous access and laryngeal mask application. Intervention frequencies varied considerably between hospitals and countries. CONCLUSIONS: This study provides comprehensive data on the use of supportive interventions in neonatal resuscitation from different countries around the world. The findings can inform the development of future resuscitation guidelines and training programs. In addition, the data highlight the need for improved dissemination of evidence-based practices to ensure consistent and optimal care for neonates in the DR.