NRP

 Assign Roles

• Leader

• Airway

• Pulse ox, auscultation/EKG, adjust FIO2

Assemble equipment:

• Warm

  • Warmer

  • Towel/blankets to dry and remove

  • Temp sensor for prolonged resuscitation

  • Hat

  • Plastic bags/wrap if <32w

  • Thermal mattress if <32w

• Ventilation

  • O2 set to 10L/min

  • If available, Oxygen blender set to 21%

  • T-piece resuscitator (for free-flow, CPAP and PPV)

    • Preterm FiO2 30%

    • <32 weeks, start CPAP immediately, low pressures (20/5)

      • Adjust FiO2 for sat

      • Adjust PEEP (max 7) for work of breathing

  • Term/pre-term size mask, and self-inflating bag

•  Suction

  • Suction bulb syringe

  • 10-12F suction catheter attached to wall 80-100mmHg suction

  • Meconium aspirator

• Alternative Airway Equipment

  •  LMA size 1 and 5mL syringe

  •  Laryngoscope: 

    • Miller 0 preterm

    • Miller 1 term

  • ETT: 2.5-4

    • Size

      • 3mm for 28-34w

      • 3.5mm 34-38w

      • 4mm >38w

    • Depth of insertion

      • Gestation-based guidelines or use of the nasal-tragus length method

  • Stylet

  • Muko

  • Syringes

• Monitor

  • Stethoscope

  • Cardiac/ECG monitor

  • SpO2 - Pulse Oximeter

  • CO2 capnography

• Medications

  • Peripheral IV preferred over umbilical line

  • Umbilical line kit

    • 3x Chlorhexidine swabs

    • Sterile drapes

    • Sterile gloves

    • Pick-up forceps (without teeth)

    • Scalpel

    • Gauze

    • Sterile tie tape

    • Tape

    • 3-way stop cock

    • Syringes (1mL, 3mL)

    • NS Flush

    • 5Fr Umbilical catheter (Can use Size 5 feeding tube as alternative)

  • Epinephrine [0.1mg/mL] (at 0.1mg/kg ETT) or diluted to get 0.01mg/kg UV/IV/IO

    • 10mL NS Flush and 18G needle to dilute in 10

    • 10mL NS Flush (to flush 2mL after Epi UV/IV/IO)

  • 250mL NS

  • D10W at TFI 80mL/kg/day, aim for glucose ≥2.7, check q3 hours x 3

  • Ampi/Genta and blood cultures if indicated (eg. preterm delivery without clear precipitant)

  • Atropine/Fentanyl/Succ or Roc if intubation

• For vigorous term and preterm infants, delayed cord clamping for 30 to 60 s is recommended

• When meconium is present and the newborn is hypotonic with ineffective respirations, ‘routine intubation for tracheal suction is not suggested’. 

  • Initial resuscitation and administration of PPV should be undertaken, as required. 

  • Meconium remains a risk factor for abnormal transition and a team with advanced resuscitation skills should be present

• For the term infant, resuscitation should start with 21% oxygen. 

  • For preterm infants <35 weeks’ gestational age, recommended initial gas is 21%–30% oxygen

• After 15 s of PPV, assessment of HR should take place. 

  • If HR is not increasing, chest rise should be evaluated. If the chest is moving, a further 15 s of PPV should be administered before reassessment of HR. 

  • If the chest is not moving, corrective steps (MR.SOPA) should be initiated. HR should be reassessed after 30 s of ventilation that moves the chest