49( until there are &ilateral &reath sounds and visi&le chest movement.
If sti not e$ective,
9) Consider airway alternative 8endotracheal tu&e or laryngeal mas% airway9
19. ,sta&lishing e2ective ventilations is the highest $riority in neonatal resuscitation. 3o not start
chest com$ressions without 5rst esta&lishing e2ective ventilation 8de5ned &y audi&le
&ilateral &reath sounds and chest movement9. If heart rate is still %elow 0 %#m des#ite
=0 seconds of e>ective #ositive)#ressure ventilation& increase the o0'gen
concentration to 1001 and %egin chest com#ressions,
20. Chen the heart rate is &elow 14 &$m( the o/imeter may not "unction. Chen chest
com$ressions &egin( increase the o/ygen concentration to 144G until the o/imeter is giving
a relia&le signal and can guide the a$$ro$riate ad:ustment o" su$$lemental o/ygen.
NRP 2011: Raising the Bar for Providers and
Instructors) Revised ->?>11 Page = o"
21. Intu%ation is strongl' recommended when chest com#ressions %egin to hel$
ensure e2ective ventilation.
22. The intu%ation #rocedure ideall' should %e com#leted within =0 seconds 8not 4
seconds9. 3o not administer "ree+@ow o/ygen during the intu&ation $rocedure to an a$neic
new&orn.
23. 7nterru$tion o" chest com$ressions to chec% the heart rate may result in a decrease o"
$er"usion $ressure in the coronary arteries. Therefore& continue chest com#ressions and
coordinated ventilations for at least ?@)0 seconds %efore sto##ing %rie:' to
assess the heart rate,
24. 7" you antici$ate the need to $lace an emergency um&ilical venous catheter( continue
chest com#ressions %' moving to the head of the %ed *near the infant4s head+
and continuing the +thum& technique. This is most easily accom$lished i" the new&orn is
intu&ated.
25. The laryngeal mas% airway has &een shown to &e an e2ective alternative "or assisting
ventilation. =se may &e indicated when
1. Bacial or u$$er airway mal"ormations render ventilation &y mas% ine2ective.
2. Positive+$ressure ventilation with a "ace mas% "ails to achieve e2ective ventilation and
intu&ation is not $ossi&le.
26. A#ine#hrine is indicated when the heart rate remains %elow 0 %#m after =0
seconds of e>ective assisted ventilation *#refera%l' via endotracheal tu%e+ and
at least another ?@)0 seconds of coordinated chest com#ressions and e>ective
ventilation,
27. The intratracheal route is associated with unrelia&le a&sor$tion and is li%ely to &e ine2ective.
Nevertheless( since the endotracheal route is the most readily accessi&le( administration o" a
dose o" e$ine$hrine via an endotracheal tu&e may &e considered while the intravenous route
is &eing esta&lished.
28. ,$ine$hrine administration 87F $arameters unchanged' note new dose for intratracheal
e#ine#hrine9
1. Recommended concentration) 1)14(444 84.1 mg>mL9
2. Recommended route) 7ntravenous 8um&ilical vein9. Consider endotracheal route
0NL! while 7F access &eing o&tained
3. Hive ra$idly I as quic%ly as $ossi&le.
4. Recommended 7F dose) 4.1+4.* mL>%g o" 1)14(444 solution $er um&ilical vein in a 1+
mL syringe. Bollow 7F administration o" e$ine$hrine with 4.- I 1 mL @ush o" normal
saline.
5. Recommended intratracheal dose( 0,@ B 1 mCD.g o" 1)14(444 solution $er
endotracheal tu&e in a *+1 mL syringe.
6. Chec% the new&orn heart rate a&out 1 minute a"ter administering e$ine$hrine
8longer i" given endotracheally9. ,$ine$hrine dose may &e re$eated every *+-
minutes.
29. Thera$eutic hy$othermia "ollowing $erinatal as$hy/ia should &e
1. =sed only "or &a&ies J *1 wee%s. gestation and who meet $reviously de5ned
criteria "or this thera$y
2. 7nitiated &e"ore 1 hours a"ter &irth
3. =sed only &y centers with s$ecialiAed $rograms equi$$ed to $rovide the thera$y
30. To hel$ %ee$ the $reterm &a&y warm(
1. Increase the tem#erature of the deliver' room and the area where the
%a%' will %e resuscitated to a##ro0imatel' 2@EC to 2EC *FFE7)FGE7+
2. =se $olyethylene $lastic wra$ "or &a&ies delivered at less than 9 wee%s. gestation
8or K wee%s and less9. =se a sheet o" $lastic "ood wra$( a "ood+grade 1+gallon
$lastic &ag( or a commercially availa&le sheet o" $olyethylene $lastic.
3. Place a $orta&le warming $ad under layers o" towels on the resuscitation ta&le.
NRP 2011: Raising the Bar for Providers and
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Information for NRP Instructors
1. Eealth6tream is the vendor "or the 1
th
edition NRP online e/amination. The "ee "or the e/am
varies de$ending on how many e/ams are $urchased and how the e/amination is accessed.
7" your institution uses Eealth6tream as its Learning Management 6ystem( your learners may
receive the e/amination in the same way other hos$ital learning $rograms are o&tained. 7"
your institution is not a Eealth6tream client( you may $urchase online e/aminations in small
or large volume $urchases. Eealth6tream will set u$ a we&site "or your use. 7ndividuals may
also $urchase an online e/amination with a $ersonal credit card. Bor more in"ormation( visit
www.aa$.org>nr$ and clic% on 0nline ,/amination.
2. 6imulation training is de$endent on good methodology( not technology' there"ore(
so$histicated electronic simulators are not necessary.
3. NRP 7nstructor Maintenance Requirements 8includes Regional Trainers9
1. ,ach current NRP instructor must own a $ersonal co$y o" the NRP Instructor %&%: 'n
Interactive (oo for )aciitation of *i"uation+based ,earning and com$lete the $ost+
3F3 education activity &y Lanuary 1( 41. Hour 8I8 is licensed to one com#uter
and cannot %e used on multi#le devices a"ter launching the $rogram. Launch it
on the com$uter where it will &e viewedM
2. ,ach instructor must teach or co+teach at least courses in the years "or which
their instructor card is valid.
3. <eginning in Lanuary 41*( every NRP instructor must ta%e the online e/amination
8Lessons 1 through 99 $rior to their instructor status renewal date. <eginning in
s$ring 411( every instructor may ta%e the online e/amination once>calendar year i"
desired at no charge' however( continuing education credit may &e awarded only
once every two years.
4. NRP 7nstructor eligi&ility
1. 0nly registered nurses 8including NNPs( CNMs( etc9( $hysicians 8M3 or 309(
res$iratory thera$ists( and $hysician assistants are eligi&le to &ecome NRP
instructors. There are no e/ce$tions and no waivers. Pro"essionals who &ecame NRP
instructors &y waiver in the $ast will maintain their instructor status as long as
maintenance requirements are met.
2. NRP instructor candidates are required to meet $rerequisites $rior to their NRP
7nstructor Course. 7nstructor candidates must have current NRP $rovider status
8Lessons 1 through 99( $roduce a
letter o" recommendation and su$$ort "rom their manager>hos$ital administrator(
$ass the 1
th
edition online e/amination in the *4 days &e"ore their 7nstructor
Course 8Lessons 1 through 99( watch the NRP 7nstructor 3F3 and com$lete the
$ost+3F3 education activity( and ta%e the 7nstructor 6el"+#ssessment( which is
included in the NRP 7nstructor Manual.
NRP 2011: Raising the Bar for Providers and
Instructors) Revised ->?>11 Page @ o"
NRP
th
Adition 7low 8iagram
NRP 2011: Raising the Bar for Providers and Instructors) Revised ->?>11 Page o"