NRP NEW REVIEW DOCS FOR FINAL EXAM 2022
Focus of neonatal resuscitation - Effective ventilation of baby's lungs
Fetal circulation path - Umbilical vein >>> Liver/ductus venosus >>> IVC >>> R side of
heart >>> patent foramen ovale + blood from pulmonary arteries via ductus arterioles
>>> L side of heart >>> aorta
Transitional circulation path - 1. Baby breaths
2. Pulmonary resistance decreases and blood travels to lungs >>> air in alveoli causes
blood vessels in lungs to dilate
3. Gas exchange occurs
4. Blood returning to the left side of the heart has high oxygen saturation
Clinical findings of Abnormal Transition - 1. Irregular or absent respiratory effort (apnea)
or rapid breathing (tachypnea)
2. Slow heart rate or rapid heart rate
3. Decreased muscle tone
4. Low oxygen saturation
5. Low blood pressure
NRP Flow Chart*** -
Pre-resuscitation team briefing - 1. Assess perinatal risk factors
2. Identify a team leader
3. Delegate tasks
4. Identify who will document events as they occur
5. Determine what supplies and equipment will be needed
6. Identify how to call for additional help
,Lesson 1: Key Points - 1. Some newborns without any apparent risk factors will require
resuscitation, including assisted ventilation
2. Unlike adults, who experience cardiac arrest due to trauma or heart disease,
newborn resuscitation is usually the result of respiratory failure, either before or after
birth
3. The most important and effective action in neonatal resuscitation is to ventilate the
baby's lungs
4. Very few newborns will require chest compressions or medication
5. Prolonged lack of adequate perfusion and oxygenation can lead to organ damage
6. Resuscitation should proceed quickly and efficiently; however, ensure that you have
effectively completed the steps in each block before moving to the next
7. Teamwork, leadership, and communication are critical
Antepartum risk factors - Gestational age less than 36 weeks
Gestational age greater than 41 weeks
Preeclampsia or Eclampsia
Maternal HTN
Multiple gestation
Fetal anemia
Polyhydramnios
Oligohydramnios
Fetal hydrops
Fetal macrosomia
Intrauterine growth restriction
Significant fetal malformations or anomalies
No prenatal care
Intrapartum risk factors - Emergency C section
Forceps or vacuum assisted
Breech or abnormal presentation
, Category II or III FHR pattern
Maternal general anesthesia
Maternal Mg therapy
Placental abruption
Intrapartum bleeding
Chorioamnionitis
Narcotics administered w/in 4 hrs of delivery
Shoulder dystocia
Meconium stained amniotic fluid
Prolapsed umbilical cord
Questions before birth - 1. What is the expected gestational age?
2. Is the amniotic fluid clear?
3. How many babies are expected?
4. Are there any additional risk factors?
Personnel at delivery - 1. 1 qualified at every birth
2. Risk factors present = 2 qualified people
3. Clear risk = qualified team --> ready for endotracheal incubation, chest
compressions, emergency vascular access, meds
NRP equipment checklist - Page 25
Category I FHR - Normal tracing
Category II FHR - Indeterminate tracing - further evaluation and surveillance indicated
Category III FHR - Abnormal tracing - predictive of abnormal fetal acid base status at
time of observation; requires prompt eval and intervention
Focus of neonatal resuscitation - Effective ventilation of baby's lungs
Fetal circulation path - Umbilical vein >>> Liver/ductus venosus >>> IVC >>> R side of
heart >>> patent foramen ovale + blood from pulmonary arteries via ductus arterioles
>>> L side of heart >>> aorta
Transitional circulation path - 1. Baby breaths
2. Pulmonary resistance decreases and blood travels to lungs >>> air in alveoli causes
blood vessels in lungs to dilate
3. Gas exchange occurs
4. Blood returning to the left side of the heart has high oxygen saturation
Clinical findings of Abnormal Transition - 1. Irregular or absent respiratory effort (apnea)
or rapid breathing (tachypnea)
2. Slow heart rate or rapid heart rate
3. Decreased muscle tone
4. Low oxygen saturation
5. Low blood pressure
NRP Flow Chart*** -
Pre-resuscitation team briefing - 1. Assess perinatal risk factors
2. Identify a team leader
3. Delegate tasks
4. Identify who will document events as they occur
5. Determine what supplies and equipment will be needed
6. Identify how to call for additional help
,Lesson 1: Key Points - 1. Some newborns without any apparent risk factors will require
resuscitation, including assisted ventilation
2. Unlike adults, who experience cardiac arrest due to trauma or heart disease,
newborn resuscitation is usually the result of respiratory failure, either before or after
birth
3. The most important and effective action in neonatal resuscitation is to ventilate the
baby's lungs
4. Very few newborns will require chest compressions or medication
5. Prolonged lack of adequate perfusion and oxygenation can lead to organ damage
6. Resuscitation should proceed quickly and efficiently; however, ensure that you have
effectively completed the steps in each block before moving to the next
7. Teamwork, leadership, and communication are critical
Antepartum risk factors - Gestational age less than 36 weeks
Gestational age greater than 41 weeks
Preeclampsia or Eclampsia
Maternal HTN
Multiple gestation
Fetal anemia
Polyhydramnios
Oligohydramnios
Fetal hydrops
Fetal macrosomia
Intrauterine growth restriction
Significant fetal malformations or anomalies
No prenatal care
Intrapartum risk factors - Emergency C section
Forceps or vacuum assisted
Breech or abnormal presentation
, Category II or III FHR pattern
Maternal general anesthesia
Maternal Mg therapy
Placental abruption
Intrapartum bleeding
Chorioamnionitis
Narcotics administered w/in 4 hrs of delivery
Shoulder dystocia
Meconium stained amniotic fluid
Prolapsed umbilical cord
Questions before birth - 1. What is the expected gestational age?
2. Is the amniotic fluid clear?
3. How many babies are expected?
4. Are there any additional risk factors?
Personnel at delivery - 1. 1 qualified at every birth
2. Risk factors present = 2 qualified people
3. Clear risk = qualified team --> ready for endotracheal incubation, chest
compressions, emergency vascular access, meds
NRP equipment checklist - Page 25
Category I FHR - Normal tracing
Category II FHR - Indeterminate tracing - further evaluation and surveillance indicated
Category III FHR - Abnormal tracing - predictive of abnormal fetal acid base status at
time of observation; requires prompt eval and intervention
