The podcast is based on the 7th edition of the NRP Textbook, 2016.
The Neonatal Resuscitation Program Guidelines podcast and transcript were developed by Drs. Julia DiLabio, Emer Finan, Colin Siu, and Chloe Joynt for PedsCases.com. May 23, 2018
Here is the Summary from the podcast:
1) The approach to neonatal resuscitation in chronological order is as follows: predelivery briefing, initial stabilization, followed by ventilation and oxygenation, chest compressions, epinephrine and/or volume expansion, post-resuscitation care, and team debriefing.
2) The initial stabilization process involves warming and drying the baby, clearing the airway and providing stimulation if required. This process should take less than one minute.
3) For non-vigorous infants born through meconium-stained amniotic fluid, routine endotracheal intubation and suctioning below the cords is not recommended. A team with advanced neonatal resuscitation skills should be present given that meconium is a risk factor for abnormal transition.
4) Following initial steps, positive pressure ventilation should be started if the heart rate is below 100 bpm or the infant is apneic, gasping or has ineffective breathing. Heart rate should be reassessed after 15 seconds of PPV. If the heart rate does not increase and there is inadequate chest movement, MR. SOPA corrective measures should be used. An alternative airway such as the laryngeal mask airway or endotracheal intubation may facilitate effective ventilation if the other steps of MR. SOPA have not resulted in effective ventilation.
5) Recommendations for initial oxygen concentrations are 21% oxygen for term neonates and 21-30% for neonates <35 weeks gestational age. The oxygen concentration should be titrated until target oxygen saturations are achieved.
6) Chest compressions should be started if the heart rate remains below 60 bpm after 30 seconds of effective ventilation. An alternative airway should ideally be in place and oxygen should be increased to 100% when chest compressions are initiated. The two-thumb encircling technique should be used with a 3:1 compression to ventilation ratio. [3 compressions and 1 ventilation every two seconds.]
7) Epinephrine should be used if the heart rate remains below 60 bpm despite adequate ventilation followed by 60 seconds of chest compressions.*
*At my most recent Neonatal Resuscitation Course earlier this month, one of our mentors gave the following advice: As soon as the baby appears likely to need chest compression, it is a good idea for the team leader to assign one team member to begin to prepare the emergency umbilical vein catheter so it will be ready if needed.
8) Volume expansion may be considered if the history is suggestive of volume loss and there are signs of shock. The recommended crystalloid solution is normal saline 10 mL/kg. If there is concern for significant blood loss, packed cells should
be considered, and O-negative blood can be administered in emergency
9) Post-resuscitation care involves clinical monitoring, maintenance of
normothermia, prevention of hypoglycemia, and consideration of therapeutic hypothermia for those with suspected hypoxic ischemic encephalopathy.