1 - NRP

NRP

Neonatal Resuscitation Program

fetal circulation

oxygenated blood:

1. placenta

2. umbilical vein

3. ductus venosus, foramen ovale, ductus arteriosus

cardiopulmonary changes after birth and umbilical cord clamping

• ↓PVR

• ↑SVR

• fetal shunts close

• blood goes through lungs

surfactant

pulmonary substance that lowers surface tension in alveoli, preventing their collapse

• made by type II alveolar cells at 24-28 weeks’ gestation

• adequate amounts produced by 34-36 weeks’ gestation

preparation for delivery

• assign team roles

• set up equipment

• perform risk assessment

risk assessment

maternal diabetes

• risk of neonatal hypoglycemia or macrosomia

meconium-stained amniotic fluid

• risk of meconium aspiration syndrome

prematurity

• risk of underdeveloped organs and inadequate surfactant

initial resuscitation steps within 30 seconds postnatal

1. dry baby to prevent heat loss

2. place head in sniffing position to open airway

3. stimulate breathing

4. place baby under radiant warmer and monitor temperature

5. place pulse ox on right hand/wrist (pre-ductal) and monitor O₂ saturation

indications for positive pressure ventilation (PPV)

• apnea

• HR < 100 bpm

• gasping

PPV neonatal devices

• self-inflating bag

• flow-inflating bag

• T-piece ventilator

MR SOPA

acronym for correcting ineffective ventilation

• Mask adjustment

• Reposition airway

• Suction

• Open mouth

• Pressure increase

• Airway alternative

neonatal S_pO₂ 1 minute postnatal

60-65%

neonatal S_pO₂ every minute after 1 minute postnatal

+ 5%

neonatal O₂ and airway management

1. use room air (term) or blended air (preterm)

2. titrate to prevent oxidative injury (never use 100% O₂!)

3. target saturation by minute after birth

4. if PPV not effective, intubate

neonatal laryngoscope sizes

• preterm: size 0

• term: size 1

neonatal ETT sizes

• < 1 kg = 2.5 mm

• 1-2 kg = 3.0 mm

• > 2 kg = 3.5 mm

neonatal chest compressions and medications

1. if HR < 60 after 30 seconds of PPV, start compressions

2. compress and ventilate at 3:1 ratio

3. reassess HR after 60 seconds

4. if no improvement, administer 0.01-0.03 mg/kg epinephrine IV

neonatal medication access for resuscitation

• umbilical vein catheter (UVC)

• interosseous (IO)

• volume expansion: 10 mL/kg NS

post-resuscitation care for neonates

• CPAP

• mechanical ventilation

• glucose

• temperature regulation

• surfactant