Neonatal Resuscitation Program (NRP) flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Antenatal team briefing

Pre-delivery huddle that confirms risk factors, assigns roles such as airway, compressions, medications and recorder, verifies equipment, and plans how to call for extra help.

Delayed cord clamping

For term and preterm infants not needing resuscitation, defer clamping at least 30-60 seconds after birth to increase blood volume and iron stores.

Antenatal corticosteroids

Given before anticipated birth at 24-34 weeks, they accelerate fetal lung maturity and reduce respiratory distress syndrome, intraventricular hemorrhage, and neonatal mortality.

High-risk delivery staffing

Anticipated high-risk births require at least two skilled providers plus a team leader; every birth requires at least one provider skilled in neonatal resuscitation.

Three rapid birth questions

Term gestation? Good tone? Breathing or crying? If all answers are yes, the infant stays with the mother for routine warming, drying, and skin-to-skin care.

Preductal oxygen saturation targets

Targets by minute of life: 1 min 60-65%, 2 min 65-70%, 3 min 70-75%, 4 min 75-80%, 5 min 80-85%, and 10 min 85-95%.

Heart rate by ECG

A 3-lead ECG provides the most reliable heart rate during positive pressure ventilation and chest compressions; auscultation is used when ECG is unavailable.

Golden minute

Positive pressure ventilation should begin within one minute of birth for an apneic or bradycardic infant whose heart rate is below 100/min.

MR SOPA

Troubleshooting sequence for inadequate chest rise during ventilation: Mask adjustment, Reposition head, Suction, Open mouth, Pressure increase, Alternative airway.

Initial PPV settings

Peak inspiratory pressure 20-25 cm H2O, PEEP 5 cm H2O, rate 40-60 breaths per minute, and inspiratory time of about 0.3-0.5 second.

Initial FiO2 by gestation

Begin with 21% oxygen for infants at or beyond 35 weeks and 21-30% for infants below 35 weeks, then titrate to the SpO2 target.

Self-inflating bag limits

It delivers PEEP only with an attached PEEP valve and cannot provide free-flow oxygen, unlike a T-piece device.

Compression to ventilation ratio

Three compressions to one breath, about 90 compressions and 30 breaths per minute, delivered with 100% oxygen.

Start compressions when

Begin when the heart rate stays below 60/min after 30 seconds of effective positive pressure ventilation with 100% oxygen.

Two-thumb technique

Both thumbs press the lower third of the sternum while the hands encircle the chest; depth is one third of the anteroposterior diameter.

Compression reassessment

Check the heart rate about every 60 seconds, preferably by ECG, and stop compressions once the heart rate is at least 60/min.

IV epinephrine dose

0.01-0.03 mg/kg (0.1-0.3 mL/kg of 0.1 mg/mL), rapid push with flush, repeated every 3-5 minutes while the heart rate stays below 60/min.

Endotracheal epinephrine dose

0.05-0.1 mg/kg (0.5-1 mL/kg of 0.1 mg/mL) when no vascular access exists; absorption is unreliable, so place an IV or IO promptly.

Volume expander

10 mL/kg of 0.9% saline or type O Rh-negative blood over 5-10 minutes when hypovolemia is suspected and the response to resuscitation is poor.

Emergency umbilical venous line

Insert the catheter 2-4 cm into the umbilical vein, confirm free blood return, and use it for epinephrine or volume during resuscitation.

Therapeutic hypothermia

For infants ≥36 weeks with moderate-to-severe hypoxic-ischemic encephalopathy: cool to 33.5-34.5°C for 72 hours, starting within 6 hours of birth.

Post-resuscitation temperature

Keep axillary temperature between 36.5 and 37.5°C; hyperthermia after hypoxia-ischemia is associated with worse neurologic outcomes.

Post-resuscitation oxygen target

Titrate inspired oxygen to a preductal SpO2 of 90-95% and avoid sustained hyperoxia once the infant's condition is stable.

Glucose after resuscitation

Screen blood glucose in any infant who required resuscitation and treat hypoglycemia promptly; also watch for hypocalcemia and metabolic acidosis.

No heart rate at 10-15 min

After 10-15 minutes of continuous and effective resuscitation with no heart rate, redirecting care to comfort measures is a reasonable, individualized decision.

Apgar score role

It documents the newborn's condition at 1 and 5 minutes but must not be used to guide or time resuscitation interventions.

Closed-loop communication

The leader directs an order to a named team member, who repeats it back and reports completion, reducing errors during resuscitation.

Debriefing

A brief structured review after a resuscitation identifies what worked, what failed, and system gaps, improving future team performance.

Meconium-stained amniotic fluid

Do not suction routinely; ventilate a non-vigorous infant and intubate with tracheal suction only if airway obstruction is suspected.

Congenital diaphragmatic hernia

Avoid face-mask ventilation, intubate early, decompress the stomach with an orogastric tube, and use the lowest effective inflation pressure.

Tension pneumothorax

Sudden deterioration with asymmetric breath sounds and chest movement; treat with needle aspiration at the second intercostal space in the midclavicular line.

Naloxone after maternal opioid

Ventilation comes first; naloxone 0.1 mg/kg IM or IV is considered only after effective ventilation is established, not as initial resuscitation.