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VOL 22 NO 2 FALL/WINTER 2013

Suctioning theNewborn at Birth:Questionsand Answers

facebook.com/TheNRP

Instructor Update

I hear that the AAP/AHA Neonatal Resuscitation

Guidelines call for tracheal suctioning of the non-

vigorous meconium-stained newborn, but that the

procedure doesnt actually make any difference

to neonatal outcome. Why are we still doing this

procedure if it does not influence outcome or

prevent meconium aspiration syndrome?

The International Liaison Committee on Resuscitation

(ILCOR) still recommends tracheal suctioning for

the non-vigorous meconium-stained newborn. After

reviewing the evidence, the last ILCOR statement

regarding this was the following, which answers the

question above(from Kattwinkel et al. Circulation

2010; 122;S909-S919)

Although depressed infants born to mothers with

meconium-stained amniotic fluid (MSAF) are at

increased risk to develop MAS, tracheal suctioning

has not been associated with reduction in the

incidence of MAS or mortality in these infants.

The only evidence that direct tracheal suctioning

of meconium may be of value was based on a

comparison of suctioned babies with historic controls,

and there was an apparent selection bias in the group

of intubated babies included in those studies. In

the absence of randomized, controlled trials, thereis insufficient evidence to recommend a change

in the current practice of performing endotracheal

suctioning of nonvigorous babies with meconium-

stained amniotic fluid (Class IIb, LOE C). However, if

attempted intubation is prolonged and unsuccessful,

bag-mask ventilation should be considered,

particularly if there is persistent bradycardia.

To summarize, the available evidence was not strong

enough to support or refute the practice. The NRP

Steering Committee has been careful to not change

from one unfounded practice to another, but rather to

advocate for better evidence in order to inform futureguidelines. Because the review highlighted how little

evidence there was for meconium suctioning of non-

vigorous, meconium-stained newborns, there is now a

national call for an appropriate clinical trial to be done

to assess safety and efficacy of this long-standing

clinical practice. In the meantime, it seems prudent to

continue with our current practice.

ALTHOUGH DEPRESSED INFANTS BORN TO MOTHERS WITH MECONIUM-STAINED AMNIOTIC FLUID (MSAF) ARE

AT INCREASED RISK TO DEVELOP MAS,TRACHEAL SUCTIONING HAS NOT BEEN ASSOCIATED WITH REDUCTION

IN THE INCIDENCE OF MAS OR MORTALITY IN THESE INFANTS.

continued on page 5


2/12

In This Issue

1 Suctioning the Newborn at Birth:

Questions and Answers

3 Improve Your Debriefing Skills

6 Preparing NRP Learners for Success:

The Online Examination

8 NRP Online Exam At-A-Glance

10 Tore Laerdal Becomes Honorary

Fellow of the AAP

12 Welcome and Farewell

12 NRP Research Grant Award

12 Reminder to Instructors to

Complete Exam


NRPAcknowledgements

The Neonatal Resuscitation Program(NRP)

Steering Committee offers the NRP Instructor Update

to all AAP/AHA NRP Instructors.

Editor

Eric C. Eichenwald, MD, FAAP

Managing Editors

Rachel Poulin, MPH

Wendy Marie Simon, MA, CAE

Robyn Wheatley, MPH

Contributor

Jeanette Zaichkin, RN, MN, NNP-BC

NRP Steering Committee

Steven Ringer, MD, PhD, FAAP, Cochair

Brigham & Womens HospitalBoston, MA

Myra H. Wyckoff, MD, FAAP, Cochair

University of Texas Southwestern Medical Center

Dallas, TX

Anne Ades, MD, FAAP

The Childrens Hospital of Philadelphia

Philadelphia, PA

Christopher Colby, MD, FAAP

Mayo Clinic

Rochester, MN


University of Texas-Houston Medical School

Houston, TX

Kimberly D. Ernst, MD, MSMI, FAAP

University of Oklahoma Health Sciences Center

Oklahoma City, OK

Henry C. Lee, MD, FAAP

Stanford University

Palo Alto, CA

Marya Strand, MD, FAAP

Saint Louis University

St. Louis, MO

NRP Editors

John Kattwinkel, MD, FAAP

University of Virginia

Charlottesville, VAGary M. Weiner, MD, FAAP

Saint Joseph Mercy Hospital

Ann Arbor, MI

Jeanette Zaichkin, RN, MN, NNP-BC

Providence St. Peter Hospital

Olympia, WA

NRP Steering Committee Liaisons

John T. Gallagher, MPH, RRT-NPS

American Association for Respiratory Care

Rainbow Babies & Childrens HospitalCleveland, OH

Linda McCarney, MSN, RN, NNP-BC, EMT-P

National Association of Neonatal Nurses

The Childrens Hospital in Denver

Aurora, CO

Patrick McNamara, MB, FRCPC

Canadian Paediatric Society

The Hospital for Sick Children

Toronto, ON, Canada

Samuel Mujica Trenche, MD, FAAP

Section on Hospital Medicine

Las Vegas, NV

NRP Steering Committee Consultants

Louis P. Halamek, MD, FAAP

Stanford University

Palo Alto, CA

Jeffrey Perlman, MB, ChB, FAAP

ILCOR Science Director

Liaison AHA Pediatric Subcommittee

New York Presbyterian Hospital

New York, NY

Jerry Short, PhD

University of Virginia

Charlottesville, VA

AAP Staff Liaisons

Thaddeus Anderson

Kristy Crilly

Nancy Gardner

Jackie Hughes

Kirsten Nadler, MS

Rachel Poulin, MPH

Wendy Simon, MA, CAE

Robyn Wheatley, MPH

Statements and opinions expressed in

this publication are those of the authors

and are not necessarily those of the

American Academy of Pediatrics orAmerican Heart Association.

Comments and questions are welcome

and should be directed to:


Editor, NRP Instructor Update

141 Northwest Point Blvd., PO Box 927

Elk Grove Village, IL 60009-0927

www.aap.org/nrp

American Academy of Pediatrics/

American Heart Association, 2013


3/12

Improve Your Debriefing Skills

How can I prepare my learners for a

successful debriefing?

Prepare your learners ahead of time for what they

can expect during debriefing. Your provider course

should include a short orientation about how the

course is set up, including learner responsibilitiesfor participation. If participants are new to simulation

and debriefing, they should be told that debriefing

is when the instructor helps the learners talk to

each other about what went well and what could

have gone better during the scenario. As participants

gain experience with simulation and debriefing,

their skills at eliciting meaningful discussion from

their colleagues also improve. Debriefing is guided

by the instructor, but participants must engage

in the process.

What is the first question to ask at a debriefing?

Some instructors fear instructor freeze, which

occurs when an instructor faces the scenario

participants and cannot think of a single word

to begin the debriefing except, So

Avoid instructor freeze by remembering that your

first question should always establish the existence

of a shared mental model. Based on your information

about the infants gestation and risk factors, did

your learners see the newborns presentation as

you had planned? Ask, Tell me what you thought you

would need to do when the newborn first came

to the radiant warmer. Its a good idea to address this

first question to a less dominant member of the teambecause this person is unlikely to challenge a more

assertive team member who voices a different view of

the newborns initial status.

For example, imagine that your learning objectives

include tracheal suction for a non-vigorous meconium-

stained newborn. However, team members fail to ask

if the fluid was meconium-stained, and you do not

apply any substance to the newborn that resembles

meconium. The newborn was placed on the radiant

warmer where the team quickly proceeded through

initial steps and positive-pressure ventilation. Your

first question at the debriefing, addressed to a quieter

team member, is, Tell me what you thought you would

need to do when the newborn first came to the radiant

warmer. The reply, The newborn was limp, apneic,

and had a low heart rate so we proceeded with initial

steps. It is then clear to you that the team did not

anticipate or see meconium-stained fluid, and you did

not have a shared mental model of this scenario. You

may now conclude that the team did not necessarily

fail to intervene properly they simply missed the cues

they needed to manage a non-vigorous, meconium-

stained newborn at birth. You would correct this prior

to the next scenario by reminding team members to

ask the four questions prior to the birth to assess risk (if

the team does not recognize this during this debriefing)and you would apply a meconium-like substance to

the infant to provide an essential visual clue about the

newborns condition.

continued on page 4

NRP INSTRUCTOR UPDATE

NRPintroduced the simulation-based curriculum nearly two years ago. By now, most NRP instructors

have had an opportunity to conduct provider courses that include the required simulation and debriefing

component. Most instructors feel confident creating learning objectives and setting up scenarios;

however, many instructors ask the following questions about debriefing.

DEBRIEFING IS A FACILITATED INTERACTIVE

DISCUSSION ABOUT A PRIOR SERIES OF EVENTS.

THE INSTRUCTOR GUIDES THE DISCUSSION

WITH OPEN-ENDED QUESTIONS AND

ALLOWS REFLECTION AND SELF-DISCOVERY.

DEBRIEFING IS WHEN LEARNING OCCURS.


4/12


What other debriefing questions keep the discussion

moving forward?

Most provider courses have limited time for debriefing.After the shared mental model question described

above, the most important questions to ask include

the following:

What went well with your scenario?

What could have gone better?

What will you do differently next time?

Look at this list of NRP Key Behavioral Skills

and give an example of a skill you used (or

should have used to improve performance)

Do not allow team members to simply read off thelist of NRP Key Behavioral Skills, such as, I used

all available resources. The response requires

an example such as, When I paged anesthesia

to help with this difficult intubation, I used all

available resources.

Team members may not initially recognize their

behaviors as NRP Key Behavioral Skills. For example,

in response to your question about what went well,

a team member may state that she checked

equipment prior to the birth to make sure she had

everything needed, and she called an NNP to attend

the birth because of meconium-stained fluid. Thisteam member might need your help to recognize

these actions as Know Your Environment and Plan

and Anticipate. By naming the Behavioral Skills

team members may not even be aware that they use,

they can translate these skills into use when they

participate on teams that do not function well.

If the scenario is complex or if something unexpected

occurs such as a medication error or a breach of

professional behavior, it may be helpful to plan the

debriefing agenda with team members. Prior to asking

the shared mental model question, ask participants

to identify the issues they wish to discuss. List these

on a whiteboard or screen to help keep the discussion

focused on the issues at hand.

Stay alert for responses such as, I wish she would

have told me and I didnt know Or All I

needed was When these occur, this is your

opportunity to help improve team performance by

asking, How would that sound? or How could she

have told you or How could you have gotten the

help you needed?

Before your provider course adjourns, ask each

learner, What did you learn today? This helps

reinforce the concept that simulation and debriefing

is for learning, not for demonstrating perfect skills

and behaviors.

How can I get a quiet learner to speak up?

Begin a debriefing by asking a less dominant team

member the first question, which is the shared mentalmodel question, Tell me what you thought you would

need to do when the newborn first came to the radiant

warmer. Because there is no right or wrong answer

to this question, it may help put nervous learners

at ease. Quiet learners can also be brought into the

discussion by directing questions to them by name,

for example, Steve, how effective was the first try at

positive-pressure ventilation and how did the team

respond? Give the learner some time to formulate

an answer. Silence is not necessarily a bad thing.

The instructor who asks rapid-fire questions and

answers them without waiting for the teams response

soon has a silent and passive team who allows the

instructor to do all the talking. This is not beneficial

learning for anyone.

How can I strengthen my debriefing skills?

Review the NRP Instructor DVD.

Debrief everything. If you practice debriefing only

during NRP courses, it will take a long time to

become a skilled debriefer. Use debriefing skills

after every birth and after any event or procedure

that requires teamwork and communication.

Film yourself debriefing and view it after the course.Assess your skills by using the NRP Instructor

Simulation and Debriefing Checklist on page 140

of the Instructor Manual for Neonatal Resuscitation.

continued from page 3

Improve Your Debriefing Skills

LEARN MORE BY READING THE CHAPTERS ABOUT SIMULATION AND DEBRIEFING IN THE INSTRUCTOR

MANUAL FOR NEONATAL RESUSCITATION (2011).


5/12

continued from page 1

Suctioning the Newborn at Birth Q&A

What research is in progress on this topic? Is it

possible that the guideline for tracheal suctioning

will change with the next AAP/AHA guidelines?

It is possible, but it will depend on timing of when

studies are completed and the results of those studies.

What is the current advice about intubating and

suctioning the trachea twice when suctioning

meconium from the trachea?

If during tracheal suctioning there is return of

meconium, the provider may intubate a second time

as long as the heart rate allows. If the heart rate is

< 100 bpm then one attempt is all that should be

done, and then PPV should be initiated. If PPV does

not result in an increase in the heart rate, additionalsteps to improve ventilation should be initiated.

These include checking the mask seal, repositioning

the infant in the open airway position, suctioning

the mouth and nose again, opening the mouth,

increasing pressure and placement of an advanced

airway (MRSOPA). The best indicator that effective

ventilation is in progress is stabilization of the heart

rate above 100 bpm.

Can you explain why there is no difference in risk

between thin vs. thick meconium? I know this is old

information, but healthcare providers at our hospital

still consider thick meconium a more ominous sign

than thin meconium. Is there any way to predict the

neonatal risk based on the consistency of meconium?

The term thin versus thick is very subjective.

In addition, there is no data to support that

meconium consistency predicts risk or outcome.

If the amniotic fluid is meconium-stained and the

infant is vigorous, no matter what the consistency,

the infant should be treated like any other newborn.

If the amniotic fluid is meconium-stained and the

infant is non-vigorous, the medical provider should

attempt to clear the airway with tracheal suctioning

prior to stimulation, regardless of the consistency.The continued use of the terms in some hospitals

is likely a vestige of the out of date practice in

NRP editions 1 through 3 when the various

recommendations for meconium management

depended on the designation of thin versus thick.

These recommendations were not evidence-based,

but rather came from expert opinion. Starting in

2000, the NRP Steering Committee joined ILCOR

to review the available science for resuscitation

recommendations. At that time meconium

management strategies were changed from being

based on the consistency of the meconium to being

based merely on the presence of any meconium inaccordance with the best available evidence.

The current resuscitation guidelines discourage

the use of bulb suction for a newborn who has no

impedance to breathing. Does this also apply to

the OB provider who delivers the infant? Our OB

providers are not allowed to have a bulb suction

device on their instrument tray, although it seems

that a little suction might be a good idea for term

vigorous newborns who are breathing and crying,

but bubbling and gargling on secretions.

ACOG gives no specific guidance on this issue in the

circumstance of clear fluid. The authors of Williams

Obstetrics textbook suggest what the AAP/AHA

guidelines suggests, that routine suctioning of every

infant is not needed. Suctioning should be reserved

for those newborns who are unable to clear their

own airway (either apneic or choking on copious

secretions). Thus, it would seem prudent to allow the

OB provider to have access to a bulb syringe to use

with good clinical judgment about when to suction.

In the circumstance of a newborn born through

meconium-stained amniotic fluid, the current ACOG

statement (reaffirmed in 2013) mirrors what is said

in the AAP/AHA guidelines. There is no evidence tosupport routine intrapartum suctioning of meconium

by the OB provider. If meconium is present and the

newborn is depressed, the clinician should intubate

the trachea and suction meconium from beneath the

glottis. If the newborn is vigorous, there is no evidence

that tracheal suctioning is necessary.



6/12

Healthcare professionals who are required to take an NRP

Provider course every two years can be unaware of courserequirements. Many errors are related to the NRP online exam.

NRP instructors report frustration with colleagues who:

Seem surprised to learn that the NRP online exam should have

been taken (and passed) prior to the course.

Take only Lessons 1-4 and 9 when their hospital requirement

is actually Lessons 1-9.

Wait until the night before the course to take the online exam,

fail it, and do not know how to access another exam before the

next day.

This type of miscommunication can be avoided. As an NRP

instructor, you can make essential course information, especiallyabout the online exam, accessible and easy to understand. If you

send NRP information as an email, make the subject line direct

and informative, such as NRP Course 2/14 at 0900: Pre-course

Requirements.

Put the most important information at the beginning of the

message. Create a standardized process for NRP participants and

keep it consistent to avoid confusion. Leave white space between

facts to facilitate comprehension for those who skim quickly for

information. Use bold print or color only for the most important

information. Avoid fancy backgrounds, distracting fonts, and

overuse of photos and diagrams.

The NRP instructor is responsible for making clear and concise

information easily accessible to course participants in a timely

manner. The course participant is equally responsible for

reading the information and following instructions.

Managing Failed Exams

It is important to communicate your institutions policy forhow to handle a failed online exam. For example, your course

information might include a bold-print sentence such as This

hospital covers the cost of the first NRP Exam attempt. If you

fail any lesson twice, you must begin the entire exam again.

You are responsible for the cost of another exam. Please call

___-___-____ if you need to purchase an exam from the course

coordinator or go to http://healthstream.com/hlc/aap

to create an account to purchase an exam with your credit card

as aSelf-Registration.

You may also set an internal policy that indicates that students

will reimburse the facility for additional exams after test failure.

Your HealthStream site allows you to run a Failed Coursereportto monitor failures and identify students who owe reimbursement

for secondary attempts. Alternatively, you can turn off the auto-

reassign feature and learners will not be able to enroll in the exam

subsequent times. They will need to contact their administrator

for the exam to be reassigned and at that point they can pay for

the exam if required.

Occasionally, a student will repeatedly fail the NRP online exam.

After several failed attempts, this student requires a remediation

plan. This plan may be individualized for each learner or may

be a standard plan developed by an institution. The learning

requirements of the plan are at the discretion of the instructor

and/or the institution. The plan should include additional time

for study and test practice using the review sections for self-

assessment and summaries of Key Pointsin each lesson. The

instructors role in the remediation plan is to assess potential

reasons for repeated failure. Many experienced neonatal

providers simply fail to study the textbook or accompanying

DVD-ROM prior to taking the exam. Others may rush through

the exam and misread questions and potential answers. When

reading comprehension is clearly the issue, it may be necessary

for the instructor to sit with the student during the exam and read

the questions and potential answers aloud. The instructor should

not coach or correct wrong answers for the student.


Preparing NRPLearners for Success:The Online Examination

FOR MORE INFORMATION ABOUT THE NRP ONLINE

EXAMINATION AND SAMPLE LETTER TEMPLATES,

SEE CHAPTER 4OF THE INSTRUCTOR MANUAL FOR

NEONATAL RESUSCITATION (2011).


7/12

u You Have Registered for an NRP Provider Course

Date: Time:

Location:

(Insert link to directions if necessary.)

u Course Requirements:

Read the Textbook of NeonatalResuscitation, 6th editionor

view the textbook DVD-ROM.

Access a textbook and/or

DVD-ROM. (Insert instructions

specific to your institution.)

Pass the NRP online examination prior to the course,

but no sooner than 30 days before the course date.

See below for instructions about the online examination.

Bring your printed online examination verification from

the NRP online examination to the course.You will not

be admitted to the course without this document.

You Are Assigned:

qLessons 1-4 and Lesson 9

qLessons 1-9

qLessons 1-4, Lessons __, __, __, __, and Lesson 9

Demonstrate the above assigned neonatal resuscitation

lessons within the context of a clinical scenario in correct

sequence according to the NRP flow diagram, with

correct timing and proper technique. See textbook pages

299-302 as your guide.

Participate in simulation training and debriefing exercises

After you have attained NRP Provider status,

we recommend that you register with the

American Academy of Pediatrics for an online

reminder before your next renewal date:

www2.aap.org/nrp/provider_info-notify_service.html.

u Information About the NRP Online Examination

Access the NRP online exam by .

(Insert instructions here specific to your institution.)

If you fail any of the lesson exams twice, you will not be

able to continue the exam. The American Academy ofPediatrics deems that you must begin again with a new

examination. If you must begin anew, .

(Insert instructions specific to your institution.)

After exam completion, print your online examination

verification and bring this with you to the NRP course.

You will not be allowed to do the hands-on portion of

the course without this document.

You may start and stop the exam at your convenience, but

you must finish testing within 14 days of your original start

date. Most learners require about one hour when testing on

all nine lessons.

Take Lesson 9 last. If you take Lessons 1-4 and then take

Lesson 9, the application perceives that you have finished

the exam and locks you out of Lessons 5-8.

If you pass a lesson exam, you may print the questions you

missed. If you fail the lesson exam, you will not know which

questions you missed.

If you have questions, contact .

(Insert course contacts information here.)

Sample NRPProvider Course Information


AS AN NRP INSTRUCTOR, YOU CAN MAKE ESSENTIAL COURSE INFORMATION, ESPECIALLY ABOUT THE ONLINEEXAM, ACCESSIBLE AND EASY TO UNDERSTAND.


8/12

NRPOnline Exam At-A-Glance


Definitions

The HealthStream Learning CenterLMS, also known as the

HLC, is the most adopted learning management system in

the healthcare industry with more than 3.2 million healthcare

workers actively using our system. The HLC provides a robust

yet easy to use learning platform for scheduling, assigning,

tracking, delivering, and reporting on classroom and online

learning. The HLC supports more than 70,000 online course

completions and over 100,000 student log-ins every day, all

from users in a healthcare setting.

HealthStream Content Express (HEX)is an online LMS

for healthcare organizations who dont need all the features of

the HLC. HEX features access to online learning and student

self-registration. Content Express allows customers to assign

and manage specific HealthStream content without leverage

the full LMS functionality of the HLC. Consider this a very

basic version of the HLC.

HealthStream Connectis a custom integration that usesAICC protocols to pass progress and completion data for

online courses from HealthStream to a clients own LMS.

HealthStream has built Connect integrations with Learn.com,

SABA, SumTotal, Plateau and other leading LMSs so that

customers can continue to use their existing LMS to access

HealthStream content without switching to the full HLC.

For more information, visit

www.healthstream.com/products/learning-center.aspx.

Continuing Education Credit

The NRP online exam offers up to 9 CEUs. One credit hour

is awarded for each lesson successfully completed. To

obtain Continuing Education Credit, you must enter your

licensure information in your HealthStream record. To enter

this information click on the My Profiletab, click on Manage

Discipline and License Information, click on Add Discipline/

Licenseand enter your information. If you did not enter your

license information before completing the exam, you may add

this information later. To have the CE document you need

appear, click on My Transcript, click on Neonatal Resuscitation

Program Online Examination, 6th Edition, scroll to the bottom

of the page and click Refresh Credits.

Questions are commonly received regarding implementation of the

NRP Online Exam. As we are constantly innovating, what follows is

current information about the pricing structure for the exam, as well as

updated and complete information about continuing education credit

availability by discipline.NRPONLINE

EX

AMIN

ATIO

N

Clic

kHere

Pricing Grid Individual Purchase First 50 Exams/Yr. Next 51-250 Exams/Yr. Next 250+ Exams/Yr.

HealthStream/HLC Customer N/A $16.00 $12.80 $11.20

Non-HLC Customer N/A $20.00 $16.00 $14.00Individual Purchaser $23.50 N/A N/A N/A

Current NRP Instructor No Charge N/A N/A N/A


9/12

Medical Credits

Accrediting/Approval Body:

Accreditation Council for ContinuingMedical Education

Credit Units:9.00 AMA PRA Category 1 Credit(s)

Expiration Date:5/15/2014

Statement:The American Academyof Pediatrics is accredited by theAccreditation Council for ContinuingMedical Education to provide continuingmedical education for physicians.This activity was designated for 9.00AMA PRA Category 1 Credit(s).

This program is approved by theNational Association of PediatricNurse Practitioners (NAPNAP) for 9NAPNAP Contact Hours of which 0

are pharmacology (Rx) content. TheAAP is designated as Agency #17.Upon completion of the program, eachparticipant desiring NAPNAP contacthours should send a completedcertificate of attendance, along with therequired recording fee ($10 for NAPNAPmembers, $15 for nonmembers), to theNAPNAP National Office at 5 Hanover Sq.,Suite 1401, New York, NY 10004.

The American Academy of PhysicianAssistants accepts AMA PRA Category 1Credit(s)from organizations accreditedby the ACCME.

Disciplines: Emergency Physicians,Family and General Practitioners,Gastroenterologists, Obstetricians andGynecologists, Pathologists, Pediatricians,Physicians, Physicians Public HealthCertificate, Physicians Public PsychiatryCertificate, Physicians Area ClinicalNeed, Physicians Limited License,

Physicians Osteopathic, Podiatrists,Podiatrists Limited, Radiologists,Surgeons, Pedorthist, General Internists,Non-practicing Physician

States: AK, AL, AR, AS, AZ, CA, CO, CT,DC, DE, FL, GA, GU, HI, IA, ID, IL, IN, KS,KY, LA, MA, MD, ME, MI, MN, MO, MP,MS, MT, NC, ND, NE, NH, NJ, NM, NV,NY, OH, OK, OR, PA, PR, RI, SC, SD, TN,TX, UM, UT, VA, VI, VT, WA, WI, WV, WY

Nursing Credits


American Nurses Credentialing Center

Credit Units: 9.00 Contact Hour(s)

Expiration Date: 3/7/2015

Statement: This continuing nursingeducation activity was approved by theOhio Nurses Association (OBN-001-91),an accredited approver by theAmerican Nurses Credentialing CentersCommission on Accreditation.

Program approved for 9 contact hours;approval valid through March 7, 2015.

Disciplines: Advanced PracticeRegistered Nurses, Anesthetists, CertifiedRegistered Nurse, Cardiovascular

Technologists and Technicians, Dietitiansand Nutritionists, Licensed PracticalNurses, Licensed Vocational Nurses,Medical Assistants, Midwives, CertifiedNurse, Nurse Practitioners, NursingAides, Registered Nurses, RegisteredNurses Advanced Registered NursePractitioner, Respiratory Therapists,Respiratory Therapists CertifiedRespiratory Care Therapist, RespiratoryTherapists Critical Care Practitioner,

Respiratory Therapists Non-critical CarePractitioner, Clinical Nurse Specialist,Prehospital Registered Nurse

States: AK, AL, AR, AS, AZ, CA, CO, CT,DC, DE, FL, GA, GU, HI, IA, ID, IL, IN, KS,

KY, LA, MA, MD, ME, MI, MN, MO, MP,MS, MT, NC, ND, NE, NH, NJ, NM, NV,NY, OH, OK, OR, PA, PR, RI, SC, SD, TN,TX, UM, UT, VA, VI, VT, WA, WI, WV, WY

Respiratory Therapy Credits


American Association for Respiratory CareCredit Units:9.00 Contact Hour(s)


Statement:This program has beenapproved for a maximum of 9 contacthours of Continuing Respiratory CareEducation (CRCE) credit by the AmericanAssociation for Respiratory Care, 9425N. MacArthur Blvd., Suite 100, Irving, TX75063, Course #128636000.

EMS Credits


Continuing Education CoordinatingBoard for Emergency Medical Services

Credit Units: 9.00 Contact Hour(s)


Statement: This continuing educationactivity is approved by the AmericanAcademy of Pediatrics, a CECBEMSaccredited organization.

You have participated in a continuingeducation program that has receivedCECBEMS approval for continuingeducation credit. If you have any

comments regarding the quality of thisprogram and/or your satisfaction with it,please contact CECBEMS at: CECBEMS,12200 Ford Rd., Suite 478, Dallas, TX75234, Phone: 972/247-4442,Email: [email protected].

CECBEMS represents only thatits accredited programs have metCECBEMS standards for accreditation.These standards require soundeducational offerings determined bya review of its objectives, teachingplan, faculty, and program evaluation

processes. CECBEMS does not endorseor support the actual teachings, opinionsor material content as presented bythe speaker(s) and/or sponsoringorganization. CECBEMS accreditationdoes not represent that the contentconforms to any national, state or localstandard or best practice of any nature.No student shall have any cause ofaction against CECBEMS based on the

accreditation of the material.


FOR QUESTIONS ABOUT PRICING,

DELIVERY METHODS, OR TECHNICAL

QUESTIONS, CONTACT YOUR

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10/12

I f you have ever attended an AAP National Convention andExhibition or a major simulation technology conference,you may have run into Tore Laerdal at the Laerdal Medical

booth in the exhibition hall. Mr Laerdal enjoys chatting

with conference attendees and exchanging ideas aboutprofessional education and simulation science. You may not

have known that you were in the company of the Chairman

of Laerdal Medical, a Norwegian family-owned company

started by Asmund S. Laerdal in the 1940s and directed

by Tore Laerdal, his son, for more than 30 years.

The Laerdal Company in Stavanger, Norway began by

making childrens books and wooden toys in the 1940s.

The companys toy doll Anne was the first doll in Europe

made of soft PVC with natural stitched hair, soft unbreakable

parts, and sleeping eyes. At that time, no one could have

imagined where the Anne doll would lead the Laerdal

Company in its mission, which is Helping Save Lives.

When Tore Laerdal was 2 years old, his father saved him from

drowning. This experience, combined with new late 1950s

techniques in CPR, led the senior Mr Laerdal to develop

a life-size doll for training in mouth-to-mouth breathing.

Resusci Anne was the first in the Laerdal family of manikins

that have since been used to train several hundred million

people around the world in CPR techniques. Since the 1960s,

Laerdal Medical has been a leading supplier of training

materials and therapeutic equipment for acute medicine.

Tore Laerdals contributions to simulation technology,

patient safety, and global efforts to save lives of mothersand newborns in the developing world are too numerous

to mention in this limited space. Here are highlights of

Mr Laerdals most outstanding accomplishments.

Since the late 1990s and 2000s, Mr Laerdals focus shifted

from defibrillator access and technology to education of

healthcare providers through patient simulation. Laerdal

Medical has introduced developments in both hardware

and software that have changed educational methodologies.

He is responsible for the shift in the simulator industry

to include appropriate human models for neonatal and

pediatric populations. Through partnership with the AAP, he

is responsible for development of SimNewB, SimJunior,

SimplyNRP, and the new MicroSimulation platform.

Recognizing that learning technologies are effective only

when integrated within delivery of validated educational

programs, Mr Laerdal has fostered partnerships with the

American Heart Association and the National League

for Nursing. He also provided educational curriculum

to support nursing, medicine, EMS, military, and

voluntary organizations.

In the past 20 years, the Laerdal Foundation has provided

funding to nearly 2,000 projects to advance resuscitation

science, educational science, and good will initiatives.

In 2007, Mr Laerdal was influenced by the NRP Steering

Committees vision of a neonatal resuscitation curriculum

for low resource settings. The Laerdal Foundation provided

the AAP with $600,000 in startup funds, along with the

services of an educational designer and medical illustrator,

to develop materials that would become Helping Babies

Breathe (HBB) www.helpingbabiesbreathe.org.

Tore Laerdal Becomes HonoraryFellow of the AAP


In October 2013, Mr Tore Laerdal, Chairman of Laerdal Medical,

was made an honorary Fellow of the American Academy of Pediatrics.This honor has been awarded to only a few non-pediatricians who

have demonstrated tremendous commitment to children and whose

heroic efforts have helped further the AAP mission.


11/12

Mr Laerdal spearheaded a team of engineers to develop an

affordable and portable neonatal simulator to complementHBB (The NeoNatalie Newborn Simulator). NeoNatalie

includes 3 squeeze bulbs to simulate crying, breathing,

and umbilical pulse. It is now available on a not-for-profit

basis to Millennium Development Goal countries through

Laerdal Global Health.

Concerned with risk of infection due to reuse and poor

cleaning of suction devices in low resource settings,

Mr Laerdal worked with engineers to develop a suction

unit known as the NeoNatalie Penguin suction device

(www.laerdal.com/us/doc/2244/Penguin-Suction-Device)

which is made in one piece of silicone that can be boiled or

autoclaved and withstands hundreds of uses. This devicewas recognized by the World Health Organization as one of

20 breakthrough innovative technologies to help advance

the United Nations Millennium Development Goals (MDG)

to reduce child and maternal mortality. Read about the

MDG 4 and 5 at www.unmillenniumproject.org/goals/gti.htm.

Mr Laerdals commitment to HBB led to the signing of

the landmark HBB Global Development Alliance (GDA)

between USAID, AAP, NICHD, Save the Children, and

Laerdal Medical. The tremendous scale up efforts and

momentum within 18 months by GDA partners were

recognized in 2011 as GDA of the Year. Three years after

the GDA launch in 2010, Helping Babies Breathe has

been introduced in more than 60 countries and aims at

training 1 million birth attendants by the end of 2015. Close

to 50,000 NeoNatalie simulators and 150,000 Penguin

suction devices are now in use in low resource settings.

At the launch of the Saving Lives at Birth initiative,

Secretary of State Hillary Clinton stated that the U.S.

Government had partnered with Laerdal to develop

breakthrough innovation in newborn resuscitation.

As part of HBB scale up efforts in Tanzania, Mr Laerdal

provided country-level support to coordinate a 2-year

outcomes study. The results, published in Pediatricsin

February 2013, define the success of the collaborationbetween the AAP and Laerdal. After introduction of HBB,

the percentage of fresh-stillborns decreased by 24% and

infant mortality in the first 24 hours of life decreased by

an astounding 47%.

Mr Laerdal, concerned about maternal postpartum

hemorrhage, developed the MamaNatalie simulator totrain birth attendants about intrapartum care, postpartum

hemorrhage, and effective communication. MamaNatalie

received a 2011 EMS World Innovation Award. Read more

at www.emsworld.com/article/10445661/2011-ems-world-

innovation-awards?page=5.

The Laerdal Foundation funded the development of

Helping Mothers Survive (HMS), currently being piloted

by Jhpiego, an international, non-profit health organization

affiliated with The Johns Hopkins University that develops

strategies to help countries care for themselves by training

competent health care workers, strengthening health

systems, and improving delivery of care. www.jhpiego.orgThe Laerdal Foundation has earmarked $10 million

for United Nations MDG 4 and 5 projects over the

next 5 years. Read more at www.laerdalfoundation.org/

developing_countries.html.

In September 2013, Laerdal Global Health received the

Index Award (BODY Category) for its Natalie Collection

(NeoNatalie, Penguin Suction device, and MamaNatalie

contained in a backpack). The Index Awards are

recognized as the most important design awards in the

world, for designing sustainable solutions for global

challenges. Laerdal donated the large cash prize to the

International Confederation of Midwives (ICM) to supportdistribution of Helping Mothers Survive and Helping Babies

Breathe among its members in developing countries. Read

more about the Index Awards at www.designtoimprovelife.

dk/trio-of-life-saving-devices-reduce-childbirth-mortality.

Tore Laerdal is a worthy recipient of the honorary AAP

Fellow title. The American Academy of Pediatrics is

privileged and fortunate to have such a friend and

advocate in Mr Tore Laerdal.


IN THE PAST 20YEARS, THE LAERDAL FOUNDATION HAS DONATED OVER $120MILLION TO ADVANCE

RESUSCITATION SCIENCE, EDUCATIONAL SCIENCE, AND GOOD WILL INITIATIVES.


12/12

Welcome and Farewell

The NRP Steering Committee is in the

midst of a very exciting transition as it plans

and develops the next generation of NRP

materials. In July, the transition continued

as the committee welcomed a new cochair

and general member and celebrated theachievements of those who rotated off the

committee. The NRP and AAP welcome these

new members and applaud those leaving for

their efforts, commitment, and dedication.

Over the years, Jane E. McGowan, MD, FAAP has watched many

people come and go from the NRP Steering Committee. In July, it was

her turn to step aside as her tenure came to end after serving 10 years

on the committee, first as a member and then for the last four years

as a committee cochair.

During the 10 years I spent as a member of the NRP Steering

Committee, I had the privilege of working with many very talented

individuals who were truly dedicated to improving outcomes for

newborns throughout the world. As a group, we have embraced

innovative educational methodologies and, more importantly, have

never been afraid to change the paradigm if we thought it would be best

for the babies. I know of no other long-standing committees that were as

willing as the members of the NRPSC to make major program changes

when deemed necessary. I will always be grateful to Dr. David Boyle

for inviting me to join the committee, and am honored to have been

able to contribute to the committees progress. I hope to continue my

participation in NRP activities throughout my career.

Taking the cochair reins from Dr McGowan is Steven Ringer, MD, PhD,

FAAP. Dr Ringer, Assistant Professor of Pediatrics at Harvard Medical

School and editor of the NRP Online Examination is making the transition

from committee member to cochair. He is overseeing the ongoing

revisions for the NRP Online Examination and actively involved in theNRP Strategic Plan to further science and research.

It is a great honor to serve with Myra Wyckoff, MD, FAAP as cochair of

NRP Steering Committee! Beyond our responsibility to the babies, I am

proud of the committees deep sense of responsibility to the instructors

who work hard to ensure that the principles and evidence behind NRP

are brought to the learners. I look forward to continuing the long tradition

of ensuring that NRP Steering Committee members are available and

responsive to your needs and ideas, said Dr Ringer.

Marya Strand, MD, MS, FAAP joined the Committee to fill the general

member vacancy left by Dr Ringer. Dr Strand is an Associate Professor

of Clinical Pediatrics at Saint Louis University. She also serves as the

Director of the Simulation-based Medical Education Program at Saint Louis

University. Dr Strand is very excited to join the NRP Steering Committee,

I have had an opportunity to work with some of the members through

the International Liaison Committee on Resuscitation (ILCOR) Neonatal

Task Force and admire the dedicated work that the Steering Committee

does. My clinical interests are in neonatal resuscitation as well as

educational methods for teaching residents, fellows and resuscitation

teams, so the NRP Steering Committee is a great fit with my interests. I

hope to contribute to the work of the Committee and help continue the

great progress in education that NRP is providing to medical providers.

NRPOnline Examination ReminderAs a reminder, all Hospital-based Instructors and Regional Trainers are

required to complete the NRP online examination every 2 years, based

on their renewal date. However, instructors do not need to wait until

just before their renewal date to take the online examination. The exam

will be provided at no charge to instructors once per calendar year.NRP instructors can take the online examination at any time during

their 2 year instructor status period by going to the NRP homepage

www2.aap.org/nrp and clicking on NRP Online Exam and following

the instructions for NRP instructors. Not sure if youve already taken

the Online Examination during your 2 year instructor period? Go to

the NRP homepage, click on NRP Course Database and enter your

ID and password. Then click on Update Information to see the

expiration date of your NRP Instructor period and the date of the last

time your passed the NRP Online Examination.


2014 NRPResearch Grant

and Young Investigator

Award Call for Applications

The America Academy of Pediatrics (AAP)Neonatal Resuscitation Program (NRP)

Steering Committee is pleased to announce

the upcoming availability of the 2014 NRP

Research Grant and Young Investigator

Awards. The awards are designed to support

basic science, clinical, or epidemiological research

pertaining to the broad area of neonatal resuscitation.

Physicians in training or individuals within four years of completing

fellowship training are eligible to apply for up to $15,000 through

the NRP Young Investigator Award. Any health care professional

with an interest in neonatal resuscitation can submit a proposal for

up to $50,000 through the NRP Research Grant Program.

Grants are currently available to fund research projects in the

United States and Canada. The NRP Steering Committee is

particularly interested in the following research and pilot programs:

Effective delivery of ventilation

Use of oxygen

Chest compressions in the newborn

Optimization of NRP education

For more details, please review:

Perlman J, Kattwinkel J, Wyllie J, Guinsburg R, Velaphi S. Neonatal

resuscitation: in pursuit of evidence gaps in knowledge. Resuscitation.

May 2012; 83(5):545-550

The NRP Research Grant and Young Investigator Award Program

Guidelines and Intent for Application will be available in January 2014.

To obtain a copy of the guidelines, a list of potential research topics,

or a list of previously funded studies, please visit the NRP website at

www.aap.org/nrp and select the Science tab.

ComingSoon!

Steven Ringer, MD, PhD, FAAP

2013 FallWinter Iu

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Transcript of 2013 FallWinter Iu