Neonatal Resuscitation Program



Neonatal Resuscitation Program

Changes for 2012

Just a reminder of the NRP changes effective the beginning of this year.  I am sending these to everyone as a reminder of the changes as not everyone in NICU will be completing their recertification at this time.  CBU is in the process of recertification so you will see them following these guidelines effective this month.  For questions please contact Deb D., Christiana C or Anne S.

Changes to Program Components:

| |Current Practice |2012 Changes |Memorial Changes |

|Equipment |Optional: |No longer optional in delivery|OR Suites: |

| |Compressed air |rooms: |Neopuff with compressed|

| | |Compressed air source |air/blended O2 |

| |Current Practice |Oxygen blender with flowmeter |Pulse oximeters |

| |2012 Changes |Pulse oximeter |LMA |

| |Memorial Changes |Laryngeal mask airway (LMA) |CO2  detector |

| | | | |

| |Equipment |Quick Pre-Resuscitation |Any NICU delivery: |

| |Optional: |Checklist is a new tool that |In the OR hallway on a |

| |Compressed air source |allows you to check the |portable pole- |

| |Oxygen blender with flowmeter |presence and function of the |Neopuff with compressed|

| |Pulse oximeter |most essential equipment and |air/blended O2 |

| |Laryngeal mask airway |supplies in the same order as |Pulse oximeter |

| |No longer optional in delivery rooms: |they are used according to the|LMA |

| |Compressed air source |NRP flow diagram. |CO2 detector |

| |Oxygen blender with flowmeter | | |

| |Pulse oximeter | | |

| |Laryngeal mask airway (LMA) | | |

| | | | |

| |Quick Pre-Resuscitation Checklist is a new tool that allows you to check the presence and function of the most essential equipment and supplies in the same order| | |

| |as they are used according to the NRP flow diagram. | | |

| |OR Suites: | | |

| |Neopuff with compressed air/blended O2 | | |

| |Pulse oximeters | | |

| |LMA | | |

| |CO2  detector | | |

| | | | |

| |Any NICU delivery: | | |

| |In the OR hallway on a portable pole- | | |

| |Neopuff with compressed air/blended O2 | | |

| |Pulse oximeter | | |

| |LMA | | |

| |CO2 detector | | |

| | | | |

| | | | |

| | | | |

| |Suctioning | | |

| |Suctioning of mouth and nose of all babies with bulb syringe or suction catheter after delivery | | |

| |Suctioning following delivery should be reserved for babies who have obvious obstruction to spontaneous breathing or who require PPV. This include use of bulb | | |

| |syringes. | | |

| |Following new guidelines | | |

| | | | |

| |Use of Oxygen | | |

| |Term infants: | | |

| |100% oxygen for cyanosis or when PPV required | | |

| |Term Infants: | | |

| |Begin with 21% (room air) | | |

| |Preterm Infants: | | |

| |Begin with somewhat higher oxygen concentration | | |

| |Term Infants: | | |

| |Begin with 21% (room air) | | |

| |Preterm Infants: | | |

| |Begin with 40% oxygen concentration | | |

| | | | |

| |source | | |

| |Oxygen blender with flowmeter | | |

| |Pulse oximeter | | |

| |Laryngeal mask airway | | |

|Suctioning |Suctioning of mouth and nose of all babies with bulb syringe or suction catheter after delivery |Suctioning following delivery |Following new |

| | |should be reserved for babies |guidelines |

| | |who have obvious obstruction | |

| | |to spontaneous breathing or | |

| | |who require PPV. This include | |

| | |use of bulb syringes. | |

|Use of Oxygen |Term infants: |Term Infants: |Term Infants: |

| |100% oxygen for cyanosis or when PPV required |Begin with 21% (room air) |Begin with 21% (room |

| | |Preterm Infants: |air) |

| | |Begin with somewhat higher |Preterm Infants: |

| | |oxygen concentration |Begin with 40% oxygen |

| | | |concentration |

|Use of pulse oximetry |Use oxygen blender and pulse oximetry|Use pulse oximetry for both term and preterm |Will take portable pole with equipment for|

| |when resuscitating infants less than |infants when |any delivery that NICU is asked to attend |

| |32 weeks.  Target oxygen saturation |Resuscitation is anticipated |whether emergent or not. |

| |is 95%. |PPV is required for more than a few breaths |RT will include as part of shiftly check. |

| | |Central cyanosis is persistent, or you need to |NICU nurse takes responsibility for |

| | |confirm your perception of central cyanosis |placement of pre-ductal pulse oximeter  |

| | |Supplemental oxygen is given | |

| | | | |

| | |Measure pre-ductal saturation levels (right hand | |

| | |or wrist). | |

| | | | |

| | |Adjust supplemental oxygen concentration to | |

| | |achieve the target values for pre-ductal |Will begin use of targeted pre-ductal SPO2|

| | |saturations summarized in the following table: |as recommended. |

| | | | |

| | |Targeted pre-ductal SPO2 After Birth |Targeted pre-ductal SPO2 After Birth |

| | | | |

| | |1 min |1 min |

| | |60%-65% |60%-65% |

| | | | |

| | |2 min |2 min |

| | |65%-70% |65%-70% |

| | | | |

| | |3 min |3 min |

| | |70%-75% |70%-75% |

| | | | |

| | |4 min |4 min |

| | |75%-80% |75%-80% |

| | | | |

| | |5 min |5 min |

| | |80%-85% |80%-85% |

| | | | |

| | |10 min |10 min |

| | |85%-95% |85%-95% |

| | | | |

|Manometer |Optional use |Manometer should be attached to resuscitation |Not really a change as we already do this.|

| | |bag.  Start with inspiratory pressure of 20 cm | |

| | |H2O at rate of 40-60 breaths per minute to | |

| | |maintain HR >100 bpm and a gradually improving | |

| | |oxygen saturation. | |

|Chest Compressions |After 30 seconds of chest |Interruption of compressions to check HR may |Follow guidelines |

| |compressions, recheck HR |result in decreased perfusion pressure in | |

| | |coronary arteries.  Continue compressions for at | |

| | |least 45-60 seconds before stopping briefly to | |

| | |assess HR. | |

|Intubation |Intubation procedure ideally |Intubation procedure ideally completed within 30 |Follow guidelines |

| |completed within 20 seconds |seconds |Will also add CO2 detectors to airway box |

| | | |for transport |

|Laryngeal | |LMA has been shown to be effective alternative |Size 1 LMAs will be available in OR, |

|Mask Airway | |for assisting ventilation.  Use may be indicated |portable pole, and in transport airway |

| | |when facial or upper airway malformations render |box.  |

| | |ventilation by mask ineffective or when PPV with | |

| | |face mask fails to achieve effective ventilation | |

| | |and intubation is not possible. | |

| | |     | |

|Epinephrine |Recommended intratracheal dose: 0.3 |Recommended intratracheal dose: 0.5 to 1 ml/kg of|Follow new guidelines |

| |to 1 ml/kg of 1:10,000 solution. |1:10,000 solution. | |

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