Neonatal Resuscitation Program (NRP) study guide
Neonatal Resuscitation Program (NRP) · Work through your exam, one topic at a time.
The Neonatal Resuscitation Program® (NRP®) is an educational program from the American Academy of Pediatrics that conveys an evidence-based approach to the care of the newborn at birth and facilitates effective team-based care. It is built for healthcare professionals who care for newborns at the time of delivery - physicians, nurses, respiratory therapists, advanced practice providers and others who may attend a delivery or respond to a newborn who needs help breathing. The Neonatal Resuscitation Program (NRP) study guide has 8 sections and about 2,329 words.
01Antenatal Care and Team Preparation
Most deliveries need only warmth and support, but the minority that do not are won or lost before the cord is cut. Candidates must be able to name the three buckets of risk: maternal (hypertension/preeclampsia, diabetes, bleeding, infection, substance use, no prenatal care), fetal (preterm or post-term, multiple gestation, growth restriction, anomalies, abnormal fetal heart pattern, meconium), and intrapartum (malpresentation, prolonged or precipitous labor, operative delivery, cord prolapse, abruption, maternal narcotics within ~4 hours).
322 words, about 2 min02Initial Assessment and Airway/Breathing
At birth ask: Is the baby term? Is the baby breathing or crying?
295 words, about 1 min03Positive Pressure Ventilation
The single most influential intervention in neonatal resuscitation is effective ventilation. Start with a PIP of about 20–25 cmH2O and PEEP of 5 cmH2O , rate 40–60 breaths per minute, using a T-piece resuscitator or a self-inflating bag with reservoir (which needs a PEEP valve to deliver PEEP).
292 words, about 1 min04Chest Compressions
Compressions are indicated when the heart rate remains below 60/min after at least 60 seconds of effective ventilation - usually with 100% oxygen by that point. The commonest error is starting compressions for a low heart rate while ventilation is still inadequate; ventilation is always the rate-limiting step in neonatal bradycardia.
281 words, about 1 min05Medications and Vascular Access
Epinephrine is indicated when the heart rate stays below 60/min despite 60 seconds of coordinated compressions with effective ventilation , ideally with 100% oxygen. The preferred route is IV/IO: 0.01–0.03 mg/kg of the 0.1 mg/mL concentration , given as a rapid push followed by a flush; the endotracheal route requires a higher dose, is less reliable, and should be used only while access is being obtained.
301 words, about 2 min06Post-Resuscitation Care and Stabilization
After any resuscitation, the infant needs a monitored environment - usually the NICU - with continuous heart rate, respiratory, and oxygen saturation monitoring, and ideally blood pressure surveillance. Titrate oxygen to preductal SpO2 targets (approximately 88–95% once stabilized, avoiding hyperoxia), manage ventilation gently, and check a blood glucose because both hypoglycemia and hyperglycemia worsen outcome.
292 words, about 1 min07Ethics, Communication, and Team-Based Care
At the edge of viability, decisions are individualized and shared. In general, comfort-focused care is reasonable at 22 weeks and below , a provisional trial of resuscitation is reasonable around 23–24 weeks , and resuscitation is generally indicated at 25 weeks and above - but gestational age is only one factor; growth, anomalies, and the family's values matter.
290 words, about 1 min08Special Situations and NICU Resuscitation
Meconium-stained fluid: no routine intubation or tracheal suctioning - begin with the standard algorithm, suction the mouth and nose only if obstructing. Preterm (<35 weeks): start blended oxygen at 21–30%, use a T-piece for consistent PIP/PEEP, and protect temperature with a plastic wrap, hat, thermal mattress, and warm room.
256 words, about 1 min