NRP 8th Edition exam with 100% correct answers
What is the single most important and effective step in neonatal resuscitation?
Ventilation of the newborn's lungs
Abnormal Transition Findings
-Irregular Breathing, absent breathing, or rapid breathing
-Slow or fast heart rate
-Decreased Muscle Tone
-Pale Skin or Blue Skin
-Low oxygen saturation
-Low blood pressure
NRP algorithm- First Step
Antenatal Counselling
Team Debriefing
Equipment Check
After the birth of the baby, what do you ask?
1. Term Gestation?
2. Good Tone?
3. Breathing or crying?
FIVE INITIAL STEPS:
If you answer NO to any of the three questions (term, tone, breathing) what do
you do?
Warm
Dry
Stimulate
Position airway
Suction if needed
Apnea or gasping? HR <100bpm= NO with laboured breathing/cyanosis
Position airway, suction if needed
Pulse oximeter
Oxygen if needed
Consider CPAP
Apnea or gasping? HR <100bpm= YES
PPV
Pulse Oximeter
Consider Cardiac Monitor
HR STILL less than 100bpm= YES
Ensure adequate ventilation
Consider ETT or laryngeal mask
Cardiac Monitor
HR <60 bpm?
ETT or laryngeal mask
Chest compressions
Coordinate PPV-100% oxygen
UVC
HR STILL <60 bpm?
, IV Epinephrine every 3-5 minutes
If still less than 60, consider hypovolemia or pneumothorax
Rapid Evaluation
Determine if the newborn can remain with the mother or should be moved to the radiant
warmer for further evaluation
REVIEW: Three questions you ask during rapid evaluation?
1. Term?
2. Good Muscle Tone?
3. Breathing/crying?
If the answer is NO to any of these, baby should be brought to radiant warmer.
Airway
Perform the initial steps to establish an open Airway and support spontaneous
respiration
Breathing
PPV is provided to assist Breathing for babies with apnea or bradycardia
Circulation
If severe bradycardia persists despite assisted ventilation, Circulation is supported by
performing chest compressions coordinated with PPV
Drug
If severe bradycardia persists despite assisted ventilation and coordinated chest
compressions, the Drug Epinephrine is administered as coordinated PPV and chest
compressions continue
What are the 4 pre-birth questions to ask the provider before every delivery?
1. Expected Gestational Age
2. Is the amniotic fluid clear?
3. Are there any additional Risk Factors?
4. What is our umbilical cord management plan?
Equipment Check- Warm
-Preheated radiant warmer
-Towels/Blankets
-Temp Sensor/sensor cover
-Hat
-Plastic Wrap (<32 weeks)
-Thermal Mattress (<32 weeks)
Equipment Check- Clear the airway
-Bulb Syringe
-10F or 12F Suction catheter attached to wall suction set at 80-100mm Hg
-Tracheal Aspirator
Equipment Check- Auscultate
-Stethoscope
Equipment Check- Ventilate
-Sets flowmeter to 10 L/min
-Sets oxygen blender to 21% (21-30 if less than 35 weeks gestation)
-Checks presence/function of PPV devices, including pressure settings and pressure
What is the single most important and effective step in neonatal resuscitation?
Ventilation of the newborn's lungs
Abnormal Transition Findings
-Irregular Breathing, absent breathing, or rapid breathing
-Slow or fast heart rate
-Decreased Muscle Tone
-Pale Skin or Blue Skin
-Low oxygen saturation
-Low blood pressure
NRP algorithm- First Step
Antenatal Counselling
Team Debriefing
Equipment Check
After the birth of the baby, what do you ask?
1. Term Gestation?
2. Good Tone?
3. Breathing or crying?
FIVE INITIAL STEPS:
If you answer NO to any of the three questions (term, tone, breathing) what do
you do?
Warm
Dry
Stimulate
Position airway
Suction if needed
Apnea or gasping? HR <100bpm= NO with laboured breathing/cyanosis
Position airway, suction if needed
Pulse oximeter
Oxygen if needed
Consider CPAP
Apnea or gasping? HR <100bpm= YES
PPV
Pulse Oximeter
Consider Cardiac Monitor
HR STILL less than 100bpm= YES
Ensure adequate ventilation
Consider ETT or laryngeal mask
Cardiac Monitor
HR <60 bpm?
ETT or laryngeal mask
Chest compressions
Coordinate PPV-100% oxygen
UVC
HR STILL <60 bpm?
, IV Epinephrine every 3-5 minutes
If still less than 60, consider hypovolemia or pneumothorax
Rapid Evaluation
Determine if the newborn can remain with the mother or should be moved to the radiant
warmer for further evaluation
REVIEW: Three questions you ask during rapid evaluation?
1. Term?
2. Good Muscle Tone?
3. Breathing/crying?
If the answer is NO to any of these, baby should be brought to radiant warmer.
Airway
Perform the initial steps to establish an open Airway and support spontaneous
respiration
Breathing
PPV is provided to assist Breathing for babies with apnea or bradycardia
Circulation
If severe bradycardia persists despite assisted ventilation, Circulation is supported by
performing chest compressions coordinated with PPV
Drug
If severe bradycardia persists despite assisted ventilation and coordinated chest
compressions, the Drug Epinephrine is administered as coordinated PPV and chest
compressions continue
What are the 4 pre-birth questions to ask the provider before every delivery?
1. Expected Gestational Age
2. Is the amniotic fluid clear?
3. Are there any additional Risk Factors?
4. What is our umbilical cord management plan?
Equipment Check- Warm
-Preheated radiant warmer
-Towels/Blankets
-Temp Sensor/sensor cover
-Hat
-Plastic Wrap (<32 weeks)
-Thermal Mattress (<32 weeks)
Equipment Check- Clear the airway
-Bulb Syringe
-10F or 12F Suction catheter attached to wall suction set at 80-100mm Hg
-Tracheal Aspirator
Equipment Check- Auscultate
-Stethoscope
Equipment Check- Ventilate
-Sets flowmeter to 10 L/min
-Sets oxygen blender to 21% (21-30 if less than 35 weeks gestation)
-Checks presence/function of PPV devices, including pressure settings and pressure
