NRP Review

Newborn Nursery

UF Health - Jacksonville

Term gestation?

Breathing or crying?

Good tone?

Birth

What 3 things should you be asking yourself walking

into the delivery room?

Stay with mother

Keep baby dry and warm

Clear airway, if necessary

Ongoing evaluation

Birth

Term gestation?

Breathing or crying?

Good tone?

Yes

Warm, clear airway if necessary, dry, stimulate

Birth

Term gestation?

Breathing or crying?

Good tone?

No

Birth

30 sec.

HR below 100 bpm, gasping or apnea?

30 seconds have passed by. What is your next step?

30 sec.

60 sec.

If the baby’s HR is above 100 bpm, the baby is not

gasping, and is not apneic, what is your

next step?

HR below 100 bpm, gasping or apnea?

Labored breathing or persistent

cyanosis?No

Yes

Clear airwaySPO2 monitoringConsider CPAP

30 sec.

60 sec.

If the baby’s HR is below 100 bpm, the baby is gasping, or is apneic,

what is your next step?

HR below 100 bpm, gasping or apnea?

Yes

PPV,SPO2 monitoring

You are doing PPV but the HR remains below 100 bpm. What do you

do next?

Take ventilation corrective steps

List the 6 corrective steps to achieve adequate

ventilation

Corrective Steps Actions

M Mask adjustment Be sure there is a good seal of the mask on the face

R Reposition airway The head should be in the “sniffing” position

S Suction mouth and nose Check for secretions; suction if present

O Open mouth Ventilate with the baby’s mouth slightly open and lift the jaw

forward

P Pressure increase Gradually increase the pressure every few breaths, until there are

bilateral breath sounds and visible chest movement with

each breath

A Airway alternative Consider endotracheal intubation or laryngeal mask

airway

You have taken corrective steps. You have now given 30 seconds of effective PPV but

the HR remains below 60 bpm. What should you do next?

HR below 60 bpm?

Yes

Consider intubationChest compressionsCoordinate with PPV

What is the appropriate ratio of compressions to ventilation?

3 compressions to 1 ventilation.In one minute, there should be 90

compressions plus 30 breaths.

When do you stop chest compressions?

When the heart rate is greater than 60 bpm.

After 45-60 seconds of chest compressions and coordinated PPV, a team member rechecks the HR and it

remains below 60 bpm.

HR below 60 bpm?

Yes

Yes

Take ventilation corrective steps

Intubate if no chest rise!

HR below 60 bpm?

Consider:• Hypovolemia

• Pneumothorax

IV Epinephrine

Concentration:1:10,000

Dose:0.1-0.3 mL/kg

Consider intubationChest compressionsCoordinate with PPV

You are about to intubate.How do you determine what size

endotracheal (ET) tube is correct?

Gestational Age (weeks)

Weight (kg) ET Tube Size (ID, mm)

Depth of insertion* (cm from upper lip)

< 28 < 1.0 2.5 6-7

28-34 1.0-2.0 3.0 7-8

34-38 2.0-3.0 3.5 8-9

> 38 > 3.0 3.5-4.0 9-10

* Depth of insertion (cm) = 6 + weight (in kg)

How long after the dose of epinephrine should you wait before re-checking the

heart rate?

1 minuteWhile you wait, you are continuing to

give PPV and chest compressions.

During a resuscitation, you should be monitoring the infant’s oxygen saturation. Should this measurement be preductal or postductal?

Preductal (RUE).

What is the target preductal saturation at the following time intervals?

1 min

2 min

3 min

4 min

5 min

10 min

60%-65%

65%-70%

70%-75%

75%-80%

80%-85%

85%-90%