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    Neonatal resuscitation: advances in training and practice

    Each year in the US, some four hundred thousand newborns need help breathing when they are born. Due to the frequent need for resuscitation at birth, it is vital to have evidence-based care guidelines and to provide effective neonatal resuscitation training. ...

    Adv Med Educ Pract. 2017; 8: 11–19.

    Published online 2016 Dec 23. doi: 10.2147/AMEP.S109099

    PMCID: PMC5214887 PMID: 28096704

    Neonatal resuscitation: advances in training and practice

    Taylor Sawyer, Rachel A Umoren, and Megan M Gray

    Author information Copyright and License information Disclaimer

    This article has been cited by other articles in PMC.

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    Abstract

    Each year in the US, some four hundred thousand newborns need help breathing when they are born. Due to the frequent need for resuscitation at birth, it is vital to have evidence-based care guidelines and to provide effective neonatal resuscitation training. Every five years, the International Liaison Committee on Resuscitation (ILCOR) reviews the science of neonatal resuscitation. In the US, the American Heart Association (AHA) develops treatment guidelines based on the ILCOR science review, and the Neonatal Resuscitation Program (NRP) translates the AHA guidelines into an educational curriculum. In this report, we review recent advances in neonatal resuscitation training and practice. We begin with a review of the new 7th edition NRP training curriculum. Then, we examine key changes to the 2015 AHA neonatal resuscitation guidelines. The four components of the NRP curriculum reviewed here include eSim®, Performance Skills Stations, Integrated Skills Station, and Simulation and Debriefing. The key changes to the AHA neonatal resuscitation guidelines reviewed include initial steps of newborn care, positive-pressure ventilation, endotracheal intubation and use of laryngeal mask, chest compressions, medications, resuscitation of preterm newborns, and ethics and end-of-life care. We hope this report provides a succinct review of recent advances in neonatal resuscitation.

    Keywords: neonatal resuscitation, Neonatal Resuscitation Program, NRP, simulation, deliberate practice, debriefing, eSIM

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    Introduction

    Approximately 4,000,000 babies will be born in US this year.1 Around 400,000 of these babies will need help breathing and/or positive-pressure ventilation to successfully transition to life outside the womb, and as many as 12,000 will need resuscitation with chest compressions and cardiac medications to survive.2,3 Due to the frequent need for resuscitation at birth, it is vital to have birth attendants who are trained to provide neonatal resuscitation to babies in need. In the US, the Neonatal Resuscitation Program (NRP) is the primary educational mechanism used to teach health care providers to perform neonatal resuscitation. The goal of the NRP curriculum is to help neonatal care providers acquire the cognitive, technical, and behavioral skills needed to successfully and efficiently resuscitate babies at the time of birth.4

    The NRP educational curriculum is reviewed and revised in five years cycles in coordination with the International Liaison Committee on Resuscitation (ILCOR) review of resuscitation science.5 Based on the ILCOR science review, the American Heart Association (AHA) developed neonatal resuscitation guidelines and treatment recommendations.6 The NRP program then translates the AHA guidelines into an educational curriculum and develops a NRP flow diagram, which is published in the Textbook of Neonatal Resuscitation.7 This year marks the 7th edition of the NRP educational curriculum.

    In this report, we review recent advances in neonatal resuscitation training and practice. We begin by examining the new 7th edition NRP educational curriculum. Then, we examine key changes to the 2015 AHA neonatal resuscitation guidelines that affect the practice of neonatal resuscitation. We hope this report provides a succinct review of recent advances in neonatal resuscitation.

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    Advances in training

    The following are six educational components of the NRP 7th edition educational curriculum: 1) self-study of the Textbook of Neonatal Resuscitation, 2) assessment of knowledge via online examination, 3) computer-based practice via NRP eSim® (Laerdal Medical, Wappingers Falls, NY, USA), 4) Performance Skills Stations, 5) Integrated Skills Station, and 6) Simulation and Debriefing. Advances in the NRP educational curriculum from the sixth to the 7th edition are summarized in Table 1.

    Table 1

    Advances in the Neonatal Resuscitation Program (NRP) educational curriculum from the 6th to the 7th edition

    Sixth edition NRP Seventh edition NRP

    Pre-course Self-study of the Textbook of Neonatal Resuscitation Online examination Self-study of the Textbook of Neonatal Resuscitation Online examination NRP eSim®

    During the course Performance Skills Stations Performance Skills Stations

    Integrated Skills Station

    Simulation and Debriefing Integrated Skills Station

    Simulation and Debriefing

    Open in a separate window

    The 7th edition NRP educational curriculum follows an evidence-based framework known as the “Learn-See-Practice- Prove-Do-Maintain” (LSPPDM) pedagogy.8 The LSPPDM pedagogy is a six-phase framework for teaching procedural skills, assessing competency, and maintaining competency once acquired. When applied to the NRP curriculum, the LSP-PDM pedagogy is used as follows. The first phase, “Learn”, is facilitated by self-study of the Textbook of Neonatal Resuscitation, passing the online examination, and doing the online eSim® module. During the NRP course, students “See” the techniques of neonatal resuscitation demonstrated by the instructor, and “Practice” the skills using simulation during the Performance Skills Stations, and Simulation and Debriefing. During the Integrated Skills Station, the students “Prove” their proficiency in neonatal resuscitation. After course completion, students go on to “Do” neonatal resuscitation as part of clinical care. Students “Maintain” neonatal resuscitation skill through clinical practice, supplemented by simulation-based training as needed and participation in an NRP course every two years. Figure 1 provides an overview of the LSPPDM pedagogy applied to the NRP curriculum. The following are the four components of the NRP curriculum reviewed: eSim®, Performance Skills Stations, Integrated Skills Station, and Simulation and Debriefing.

    Source : www.ncbi.nlm.nih.gov

    NRP 7th edition part 2 Flashcards

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    A laboring woman received a narcotic medication for pain relief 1 hour before delivery.The baby does not have spontaneous respirations and does not improve with stimulation.Your first priority is to

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    Start positive-pressure ventilation

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    During resuscitation, a baby is responding to positive-pressure ventilation with a rapidly increasing heart rate. Her heart rate and oxygen saturation suddenly worsen.She has decreased breath sounds on the left side and transillumination also reveals a bright glow on the left side.What is the most likely cause of this distress?

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    Left-sided pneumothorax

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    A laboring woman received a narcotic medication for pain relief 1 hour before delivery.The baby does not have spontaneous respirations and does not improve with stimulation.Your first priority is to

    Start positive-pressure ventilation

    During resuscitation, a baby is responding to positive-pressure ventilation with a rapidly increasing heart rate. Her heart rate and oxygen saturation suddenly worsen.She has decreased breath sounds on the left side and transillumination also reveals a bright glow on the left side.What is the most likely cause of this distress?

    Left-sided pneumothorax

    Which of the following is true about the preparation and resources needed for a very preterm birth?

    Prepare the preheated radiant warmer with a thermal mattress, plastic wrap or bag, and a hat.

    Which of the following may be associated with delayed cord clamping in vigorous preterm newborns?

    Decreased need for blood transfusions

    For a newborn weighing 1 kg, what dose of 1:10,000 (0.1 mg/mL) concentration of intravenous epinephrine is indicated?

    0.1 mL

    A baby required ventilation and chest compressions. After 60 seconds of chest compressions, the electronic cardiac monitor indicates a heart rate of 70 beats per minute. What is your next action?

    Stop chest compressions; continue positive-pressure ventilation.

    How soon after administration of intravenous epinephrine should you pause compressions and reassess the baby's heart rate?

    1 minute

    What is the preferred method for assessing heart rate during chest compressions?

    Electronic cardiac (ECG) monitoring

    A baby's heart rate does not increase after intubation and the breath sounds are louder on the right side than the left side of the chest. Which of the following is a common cause of asymmetric breath sounds in an intubated baby?

    Endotracheal tube inserted too deep

    If a preterm birth is anticipated, at what temperature should the room be set?

    23ºC to 25ºC (74° F - 77° F)

    After chest compressions with coordinated ventilations are started, the heart rate should be assessed:

    After 60 seconds

    In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn?

    The newborn's parents

    You are in the delivery room caring for a preterm newborn at 27 weeks' gestation. The baby is 5 minutes old and breathing spontaneously. The baby's heart rate is 120 beats per minute and the oxygen saturation is 90% in room air. The baby's respirations are labored. Which of the following is an appropriate action?

    Administer CPAP at 5 cm H20 pressure

    You are in the delivery room caring for a preterm newborn at 27 weeks' gestation. Resuscitation has been completed and the baby is ready to be transported to the neonatal intensive care unit. Which of the following is a true statement about the baby's subsequent care?

    Monitor blood glucose levels because of the risk of hypoglycemia after birth.

    What time frame should be used to administer intravenous epinephrine?

    Rapid push, as quickly as possible

    When are chest compressions indicated?

    When the heart rate remains less than 60 beats per minute after 30 seconds of positive-pressure ventilation that moves the chest, preferably through an alternative airway.

    Which statement best describes the ethical principle(s) that guide the resuscitation of a newborn?

    The approach to decisions in the newborn should be guided by the same principles used for adults and older children.

    A baby born at 36 weeks' gestation was apneic after birth and required positive-pressure ventilation and oxygen supplementation in the delivery room. He continues to require supplemental oxygen after birth. Which of the following statements is true?

    His blood glucose level should be checked soon after resuscitation and then at regular intervals until stable and normal.

    What is the appropriate dose of 1:10,000 (0.1 mg/mL) concentration of epinephrine for endotracheal administration to a baby weighing 3 kg?

    1.5 mL

    When coordinating positive-pressure ventilation with chest compressions, how many events are performed each minute?

    30 breaths, 90 compressions

    A newborn requires complex resuscitation. You have intubated and are administering positive-pressure ventilation and chest compressions. Which 3 signs are used to evaluate the effectiveness of your actions, and the need to continue one or both of these measures?

    Respirations, heart rate, oxygen saturation

    Source : quizlet.com

    Master NRP 7th ed Flashcards

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    Master NRP 7th ed

    211cards Nursing Family Care Nursing

    Pre-ductual Spo2 Target 1 min

    60-65%

    Pre-ductual Spo2 Target 2 min

    65-70%

    Pre-ductual Spo2 Target 3 min

    70-75%

    Pre-ductual Spo2 Target 4 min

    75-80%

    Pre-ductual Spo2 Target 5 min

    80-85%

    Pre-ductual Spo2 Target 10 min

    85-95%

    Abnormal transition for a newborn

    apnea tachypnea

    Bradycardia/tachycardia

    decreased muscle tone

    low oxygen saturation

    low blood pressure

    If severe Bradycardia persists despite assisted ventilation and coordinated compressions what drug is administered?

    Epinephrine

    If severe Bradycardia persists despite assisted ventilation then circulation is supported with what?

    Chest Compressions

    Before birth, the alveoli in the fetal lungs are expanded and filled with what?

    Fluid

    Before birth, oxygen is supplied to the fetus by the what?

    placenta

    After birth, air in the alveoli causes vessels in the baby's lungs to?

    relax

    What are the 4 pre-birth questions to ask the provider before every delivery?

    Gestational age expected

    amniotic fluid clear or not

    How many babies expected

    any risk factors

    If 2 risk factors are present how many qualified people should be present solely to manage the baby?

    two

    What is the appropriate suction catheter pressure set at?

    80 to 100 mm Hg

    What is the Flowmeter set to?

    10 L/min.

    What is the oxygen blender set at for less than 35 wks gestation?

    21%-30%

    Umbilical cord clamping should be completed with how many seconds of birth?

    30 seconds

    Wet skin on a new born causes what?

    rapid body cooling (heat loss)

    What are the 3 main assessments after a newborn is born?

    Does the baby appear term

    Does the baby have good muscle tone

    Is the baby breathing or crying

    When using suction to clear secretions what should you suction first?

    Mouth

    If a baby does not have adequate spontaneous respirations and a heart rate of 100 bpm or higher within 1 minute of birth what should you begin?

    PPV

    What is the most important and effective action during neonatal resuscitation?

    Ventilation of the baby's lungs

    Auscultation on what side of a newborn's chest is the most accurate determination of heart rate?

    Left side of the chest

    Calculation for determining heart rate?

    6 seconds X 10

    (example: 6 seconds/12 beats = 120 bpm)

    What two reasons should you start PPV?

    Baby is apneic or gasping

    heart rate less than 100 bpm

    Pre-ductal stat is found where?

    Right hand or wrist

    Post-ductal is found where?

    Left arm or legs

    A laboring woman received a narcotic medication for pain relief 1 hour before delivery.The baby does not have spontaneous respirations and does not improve with stimulation.Your first priority is to

    Start positive-pressure ventilation

    During resuscitation, a baby is responding to positive-pressure ventilation with a rapidly increasing heart rate. Her heart rate and oxygen saturation suddenly worsen.She has decreased breath sounds on the left side and transillumination also reveals a bright glow on the left side.What is the most likely cause of this distress?

    Left-sided pneumothorax

    Which of the following is true about the preparation and resources needed for a very preterm birth?

    Prepare the preheated radiant warmer with a thermal mattress, plastic wrap or bag, and a hat.

    Which of the following may be associated with delayed cord clamping in vigorous preterm newborns?

    Decreased need for blood transfusions

    For a newborn weighing 1 kg, what dose of 1:10,000 (0.1 mg/mL) concentration of intravenous epinephrine is indicated?

    0.1 mL

    A baby required ventilation and chest compressions. After 60 seconds of chest compressions, the electronic cardiac monitor indicates a heart rate of 70 beats per minute. What is your next action?

    Stop chest compressions; continue positive-pressure ventilation.

    How soon after administration of intravenous epinephrine should you pause compressions and reassess the baby's heart rate?

    1 minute

    What is the preferred method for assessing heart rate during chest compressions?

    Electronic cardiac (ECG) monitoring

    A baby's heart rate does not increase after intubation and the breath sounds are louder on the right side than the left side of the chest. Which of the following is a common cause of asymmetric breath sounds in an intubated baby?

    Endotracheal tube inserted too deep

    If a preterm birth is anticipated, at what temperature should the room be set?

    23ºC to 25ºC (74° F - 77° F)

    After chest compressions with coordinated ventilations are started, the heart rate should be assessed:

    After 60 seconds

    In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn?

    The newborn's parents

    You are in the delivery room caring for a preterm newborn at 27 weeks' gestation. The baby is 5 minutes old and breathing spontaneously. The baby's heart rate is 120 beats per minute and the oxygen saturation is 90% in room air. The baby's respirations are labored. Which of the following is an appropriate action?

    Administer CPAP at 5 cm H20 pressure

    Source : www.chegg.com

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