Term gestation?
Breathing or crying?
Good tone?
N R P TM
Routine Care
Provide warmth
Clear airway if necessary
Dry
Ongoing evaluation
No
Warm, clear airway if necessary,
dry, stimulate
30 sec
No
No
Labored
breathing
or persistent
cyanosis?
Yes
Yes
Clear airway
SPO2 monitoring
Consider CPAP
PPV,
SPO2 monitoring
60 sec
No
Yes
Take ventilation
corrective steps
Post-resuscitation
care
No
HR below 60 bpm?
Yes
Consider intubation
Chest compressions
Coordinate with PPV
HR below 60 bpm?
Yes
IV epinephrine
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LESSON
Knowledge Check
Why is it important to have an organized routine for checking the
presence and function of resuscitation supplies and equipment prior
to every birth?
Besides checking presence and function of equipment, what other
resources should be assembled prior to a birth identified as highrisk?
Learning Objectives
Demonstrate an organized routine for checking presence and function
of supplies and equipment necessary for newborn resuscitation, using
the NRP flow diagram interventions as your guide.
Identify any additional preparatory routines for high-risk birth
specific to this birth setting.
Locate the Quick Pre-resuscitation Checklist in the Appendix of
this lesson.
You are notified that a woman has been admitted to the hospital in
active labor. Check your supplies and equipment to prepare for the
birth. As you work, say your thoughts and actions aloud so I will
know what you are thinking and doing.
Instructor should check boxes as the learner responds correctly. The
learner may refer to this checklist or the Quick Pre-resuscitation
Checklist that follows it to ensure the availability and function of
essential supplies and equipment.
Performance Steps
Warm:
Preheat warmer
Lay out towels or blankets
Details
Learner begins with equipment
needed for initial steps of
resuscitation and ends with
equipment needed for complex
resuscitation.
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Details
If birth is imminent, suction and air/
oxygen should be turned on and
ready for use.
Ventilate
Check presence and function
of positive-pressure
ventilation (PPV) device
Check presence of term- and
preterm-size masks
8F feeding tube and 20-mL
syringe
Intubate
Laryngoscope
Size 0 and 1 blades with bright
light
Stylet (optional)
Endotracheal (ET) tubes (2.5,
3.0, 3.5, 4.0)
End tidal CO2 detector
Laryngeal mask airway and
5-mL syringe
Medicate
Access to
1:10,000 epinephrine
Supplies for administering
medications and placing
emergency umbilical venous
catheter
Documentation supplies
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LESSON
Performance Steps
Details
Thermoregulate
For very preterm newborns
Plastic wrap or bag
Chemically activated warming
pad
Transport incubator
Other
Unit-specific items
Instructor asks the learner Reflective Questions to enable selfassessment, such as:
Tell me how using this organized approach to checking
resuscitation equipment works for you.
If all equipment and supplies were present, how long would it take
you to confirm readiness for a birth?
Did you notice anything in this Equipment Checklist that is
missing, specific to our birth setting? What would you change
about this checklist?
Neonatal Resuscitation Program Key Behavioral Skills
Know your environment.
Anticipate and plan.
Assume the leadership role.
Communicate effectively.
Delegate workload optimally.
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Appendix
Neonatal Resuscitation Supplies and Equipment
Suction equipment
Bulb syringe
Mechanical suction and tubing
Suction catheters, 5F or 6F, 8F, 10F, 12F or 14F
8F feeding tube and 20-mL syringe
Meconium aspirator
Bag-and-mask equipment
Device for delivering positive-pressure ventilation, capable of delivering
90% to 100% oxygen
Face masks, newborn and premature sizes (cushioned-rim masks
preferred)
Oxygen source
Compressed air source
Oxygen blender to mix oxygen and compressed air with flowmeter
(flow rate up to 10 L/min) and tubing
Pulse oximeter and oximeter probe
Intubation equipment
Laryngoscope with straight blades, No. 0 (preterm) and No. 1 (term)
Extra bulbs and batteries for laryngoscope
Endotracheal tubes, 2.5-, 3.0-, 3.5-, 4.0-mm internal diameter (ID)
Stylet (optional)
Scissors
Tape or securing device for endotracheal tube
Alcohol sponges
CO2 detector or capnograph
Laryngeal mask airway
Medications
Epinephrine 1:10,000 (0.1 mg/mL)3-mL or 10-mL ampules
Isotonic crystalloid (normal saline or Ringers lactate) for volume
expansion100 or 250 mL
Dextrose 10%, 250 mL
Normal saline for flushes
Umbilical vessel catheterization supplies
Sterile gloves
Scalpel or scissors
Antiseptic prep solution
Umbilical tape
Umbilical catheters, 3.5F, 5F
Three-way stopcock
Syringes, 1, 3, 5, 10, 20, 50 mL
Needles, 25, 21, 18 gauge, or puncture device for needleless system
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LESSON
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Warm
Preheat warmer
Towels or blankets
Clear airway
Bulb syringe
10F or 12F suction catheter attached to wall suction set at 80-100 mm Hg
Meconium aspirator
Auscultate
Stethoscope
Oxygenate
Ventilate
Intubate
Laryngoscope
Size 0 and Size 1 (and size 00, optional) blades with bright light
Endotracheal tubes, sizes 2.5, 3.0, 3.5, 4.0
Stylets
End tidal CO2 detector
Laryngeal mask airway (size 1) and 5-mL syringe
Medicate
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