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NeoReviews Vol.7 No.9 2006 e449
© 2006 American Academy of Pediatrics

Educational Perspectives

Changes in The Neonatal Resuscitation Program

Chad Barber, MD^*
Prameela Karimi, MD
JoDee M. Anderson, MD

^* Neonatal Fellow, Department of Pediatrics, Division of Perinatal and Neonatal Medicine, University of Texas Southwestern, Dallas, Tex
Assistant Professor, Department of Pediatrics, Division of Perinatal and Neonatal Medicine, University of Texas Southwestern, Dallas, Tex
Assistant Professor, Department of Pediatrics, Division of Neonatal and Perinatal Medicine, Oregon Health & Science University, Portland, Ore

The first 300 words of the full text of this article appear below.

	Development of New Guidelines

 
In the fall of 2005, the International Liaison Committee on Resuscitation (ILCOR) Consensus on Science and Treatment Recommendations (CoSTR) as well as the American Heart Association’s Guidelines for Emergency Cardiovascular Care (ECC) were published in Circulation. The guidelines were prepared by the American Heart Association Pediatric Subcommittee and American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee based on an extensive review of the existing literature on neonatal resuscitation. The guidelines were used to develop and revise the Textbook of Neonatal Resuscitation, 5th edition, and accompanying Neonatal Resuscitation Program (NRP) education materials. Based on their findings, various changes have been made to the NRP, including new recommendations for the use of supplemental oxygen and endotracheal epinephrine. These changes have the potential for a profound impact on medical practice around the world.

Newborns who do not require resuscitation generally can be identified by a rapid assessment of the following four characteristics:

• Was the baby born after a full term gestation?
  
• Is the amniotic fluid clear of meconium and evidence of infection?
  
• Is the baby breathing or crying?
  
• Does the baby have good muscle tone?
  

Of note, a fifth question, "Is the baby pink?" no longer appears as part of the rapid assessment immediately after birth.

The sequential approach to a newborn in the delivery room remains the same (Figure). NRP providers should continue to adhere to the ABCs of resuscitation: airway before breathing before circulation. The four categories of action in sequence are:

1. Initial steps in resuscitation (provide warmth, position, clear airway, dry and stimulate, reposition)
   
2. Ventilation
   
3. Chest compressions
   
4. Administration of epinephrine or volume expansion
   

View larger version (36K): [in this window] [in a new window]   Figure. Neonatal flow algorithm. Reprinted with permission from American Heart Association, American Academy of Pediatrics. 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal . . . [Full Text of this Article]