Neonatal resuscitation: advances in training and practice

Figures & data

Table 1 Advances in the Neonatal Resuscitation Program (NRP) educational curriculum from the 6th to the 7th edition

	Sixth edition NRP	Seventh edition NRP
Pre-course	Self-study of the Textbook of Neonatal Resuscitation Online examination	Self-study of the Textbook of Neonatal Resuscitation Online examination NRP eSim^®
During the course	Performance Skills Stations	Performance Skills Stations
	Integrated Skills Station Simulation and Debriefing	Integrated Skills Station Simulation and Debriefing

Figure 1 LSPPDM pedagogy applied to the Neonatal Resuscitation Program (NRP) curriculum.

Note: Sawyer T, White M, Zaveri P, et al. Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine. Acad Med. 2015;90(8):1025–1033. http://journals.lww.com/academicmedicine/Fulltext/2015/08000/Learn,_See,_Practice,_Prove,_Do,_Maintain___An.13.aspx.
Abbreviation: LSPPDM, Learn-See-Practice-Prove-Do-Maintain.

Figure 2 Screenshot of the Neonatal Resuscitation Program (NRP) eSim^® module.

Note: From Weiner GM, editor. Textbook of Neonatal Resuscitation (NRP). 7th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2016:10. Copyright © 2016 American Academy of Pediatrics. Reproduced with permission.
Abbreviation: ECG, electrocardiography.

Table 2 Advances in neonatal resuscitation practice with the 2015 guidelines

Initial steps of newborn care	•Begin every resuscitation with a team briefing and equipment check
	•Delay umbilical cord clamping for 30–60 seconds in vigorous term and preterm newborns
	•Do not intubate and suction the airway in non-vigorous infants born through meconium-stained fluids
	•Assess heart rate via auscultation with a stethoscope
Positive-pressure ventilation (PPV)	•Ensure PPV results in visible “chest movement”
	•Use a rising heart rate as the physiologic indicator of effective PPV
Endotracheal intubation and laryngeal mask	•Perform endotracheal intubation prior to starting chest compressions
	•Use “Initial Endotracheal Tube Insertion Depth” table or the newborn’s nasal-tragus length (NTL) + 1 cm to determine proper endotracheal tube depth
	•Use a laryngeal mask if tracheal intubation is not successful or not feasible due to lack of trained personnel
Chest compressions	•Use electrocardiography (ECG) to accurately assess heart rate
	•Continue chest compressions for 60 seconds before stopping to check the heart rate
Medications	•Do not use Lactated Ringers or sodium bicarbonate
	•Give epinephrine if the heart rate remains less than 60 bpm despite 30 seconds of effective PPV that moves the chest, and another 60 seconds of coordinated chest compression and ventilations using 100% oxygen
	•If an endotracheal dose of epinephrine is used, give a repeat intravenous dose as soon as vascular access is obtained; do not wait 3–5 minutes after the endotracheal dose
Resuscitation of preterm newborns	•Delivery room temperature should be set at ~23°C–25°C (74°F–77°F)
	•A thermal mattress, plastic wrap or bag, and a hat should be used for premature newborns less than 32 weeks’ gestation
	• CPAP can be used immediately after birth in premature newborns with respiratory distress syndrome as an alternative to routine intubation and prophylactic surfactant administration
Ethics and end-of-life care	•In cases of birth at less than 22 weeks’ gestation, and some chromosomal anomalies and congenital malformations where there is no chance for survival, neonatal resuscitation is not ethical and should not be offered
	• In cases where survival is uncertain and there is a high risk of morbidity, such as birth between 22 and 24 weeks’ gestation and some chromosomal anomalies and congenital malformations, the parents should be included in decisions regarding resuscitation plans

Abbreviations: CPAP, continuous positive airway pressure; bpm, beats per minute.

Table 3 Endotracheal tube and laryngeal mask sizes for newborns

Gestational age (weeks)	Weight (g)	Endotracheal tube size (mm)	Laryngeal mask size
<28	<1,000	2.5	N/A
28–34	1,000–2,000	3.0	1
>34	>2,000	3.5	1

Note: Data from Weiner et al.⁷

Abbreviation: N/A, not applicable.

Figure 3 Chest compression administered from the foot of the bed (A) and the head of the bed (B).

WeinerGMZaichkinJKattwinkelJTextbook of Neonatal Resuscitation7th edElk Grove Village, ILAmerican Academy of Pediatrics and American Heart Association2016

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