Neonatal Resuscitation Program (NRP) key terms

Reviewing the mother's medical history, pregnancy complications, and labor events before delivery to predict which newborns may need resuscitation and to plan who and what will be needed.

A short conversation before birth in which the team reviews the risks, assigns roles, agrees on a plan, and confirms that equipment is present and working.

Birth before 37 weeks of pregnancy. Immature lungs, weak chest muscles, fragile skin, and little body fat make breathing, warmth, and oxygen management harder.

After birth, air fills the lungs, fetal lung fluid is cleared, and blood flow to the lungs rises while the ductus arteriosus begins to close, shifting from fetal to newborn circulation.

The first actions for every newborn: provide warmth, dry the skin, stimulate breathing, position the head to open the airway, and clear secretions only if needed.

Rubbing the baby's back or flicking the soles of the feet to prompt breathing after drying, used briefly when a newborn is not crying or breathing well.

No breathing at all, or only occasional gasping breaths that do not move air. Apnea or gasping in a newborn is an indication to start positive pressure ventilation.

Bluish discoloration of the lips, tongue, and central trunk suggesting low blood oxygen. Blue hands and feet alone are common and usually normal in the first hours.

Using a light sensor, usually on the right hand or wrist, to measure oxygen saturation continuously. It is applied when resuscitation is expected or breathing is not normal.

Expected oxygen saturation ranges for each minute after birth in a term newborn. They guide how much oxygen to give and when to reduce it.

Keeping the newborn warm with a radiant warmer, warm towels, a hat, and skin-to-skin contact. Cold stress increases oxygen use and can worsen breathing problems.

Removing secretions from the mouth and nose with a bulb syringe or catheter. It is done only when secretions block breathing, and the mouth is cleared before the nose.

Using a mask, bag, or T-piece device to push air into the lungs when a newborn is apneic, gasping, or has a heart rate under 100 beats per minute.

A device that delivers a set inflation pressure and a set end-expiratory pressure through a mask when the operator closes a valve with a finger.

A hand-squeezed bag that refills on its own without a gas source. It delivers end-expiratory pressure only when a valve is attached and cannot give free-flow oxygen by mask.

The highest pressure delivered during one assisted breath. It is adjusted up or down to produce slight, visible chest movement.

Pressure maintained in the airway at the end of exhalation that helps keep small air sacs open between breaths.

Slight, gentle movement of the chest with each assisted breath, the main bedside sign that air is entering the lungs.

A memory aid for fixing ineffective mask ventilation: mask adjustment, reposition the head, suction, open the mouth, increase pressure, and try an alternative airway.

A steady level of positive pressure given to a breathing newborn with labored breathing or low oxygen to keep the lungs open and reduce work of breathing.

Passing a tube between the vocal cords into the trachea so positive pressure, oxygen, or surfactant can be delivered directly to the lungs.

A soft mask placed over the opening of the larynx, used when face-mask ventilation fails and intubation is unsuccessful or not possible.

Rhythmic pressure on the lower half of the sternum to circulate blood when the heart rate stays below 60 despite effective ventilation with oxygen.

Three compressions for every one breath, counting aloud, giving 90 compressions and 30 breaths per minute without pausing between cycles.

Placing both thumbs side by side on the lower sternum while the hands encircle the chest. Preferred for newborns because it generates better pressure and depth.

A newborn heart rate under 100 beats per minute. A rate under 60 that persists after good ventilation with oxygen is the trigger for chest compressions.

Checking the heartbeat by stethoscope, ECG, or oximeter during resuscitation. A rising heart rate is the best sign that ventilation is working.

A drug that raises heart rate and blood pressure, given by the intravenous or intraosseous route when the heart rate remains below 60 despite ventilation and compressions.

A catheter threaded into the umbilical vein during resuscitation to give epinephrine and fluids quickly when no other vascular access is available.

Giving an intravenous bolus of normal saline or blood to a newborn with poor perfusion and suspected blood loss who does not respond to resuscitation.

Controlled cooling of a newborn with signs of brain injury to about 33.5 to 34.5 degrees Celsius, started within six hours of birth and continued for 72 hours.

Brain injury caused by insufficient oxygen and blood flow around the time of birth, which can cause seizures, abnormal tone, and feeding difficulty.

Ongoing close observation after resuscitation of breathing, heart rate, temperature, glucose, perfusion, and urine output, usually in a neonatal intensive care unit.

Blood glucose below the accepted range for a newborn, common after stress or resuscitation, screened for and treated to protect the developing brain.

A brief, structured team discussion after a resuscitation about what went well, what went poorly, and what should change next time.

A team practice in which the leader names the person and the task, the receiver repeats the order back, and completion is confirmed aloud.

The gestational age and birth weight below which survival is very unlikely and resuscitation may reasonably not be started, discussed with parents beforehand.

Meconium in the fluid signals possible fetal stress. Routine intubation and suctioning are no longer done; the airway is cleared only if it is obstructed.

A defect in the diaphragm lets abdominal organs enter the chest and compress the lungs. Mask ventilation is avoided; early intubation with stomach decompression is preferred.

A clear plastic sheet or bag placed over a very preterm infant under a radiant warmer to reduce heat and water loss through thin skin.