Neonatal Resuscitation Program (NRP)

Hey guys, today we are going to talk about NRP or neonatal resuscitation program and just give a big brief overview of what this looks like.

So NRP is used in the delivery room or in those first few days of life for the newborn. So this is a protocol that you go through after the baby is born. So the first thing you’re going to assess the baby. So if the baby’s crying, vigorous, loving life, awesome, then you don’t really need NRP. You just need to dry and stimulate the baby. If that’s not the case, then we’ll go through the NRP steps. The big thing to remember is that everything you do is for 30 seconds. So you’re going to do step one for 30 seconds, step two, step three, and then maybe add some other things. That 30 seconds can seem like the longest time of your life ever but it’s when you’re going to look at that APGAR clock or timer and watch it and count everything out for 30 seconds. Let’s dive in a little bit deeper into what’s happening in each of these sets of seconds.

So our first 30 seconds, the birth happens and the first 30 seconds begins. The baby’s on the mom and we are drying and stimulating and providing warmth. As you’re drying and stimulating and rubbing with those blankets, it’s going to help to not just provide the warmth, but also stimulate that baby to cry. So if the baby’s crying and doing great, then you’re done. If that’s not the case then we are moving on to the next steps. So our next 30 seconds, if the baby has been dried and stimulated for that first 30 seconds and is not really giving you a good effort of breathing, not breathing consistently or regularly, then you’re going to give positive pressure ventilation or PPV or bag and mask.

We use something in our hospital called a Neo puff, which I think is becoming the standard and if not this is just like the ambu bag. It’s giving PPV. So however you’re giving PPV, you’re going to do that. So you give PPV and somebody else is going to be drying and stimulating. This is when you have other friends that are there helping you, right? So while you’re giving PPV, you are telling somebody else, “Hey, dry, stimulate the baby.” So that could be rubbing their foot or whatever it is just try to dry them off and get them to cry.

You should be or have one of your teammates help assess and make sure that chest rise is happening and assess that heart rate and see where we are. So our next 30 seconds, you are still giving PPV, we’re verifying correct placement. If we have not had good chest rise then we are going to verify the correct placement of that mask, make sure that ventilation is occurring right. So having somebody listen to those breath sounds to make sure that we are where we should be and that air is being put into this baby’s lungs. We are going to assess the breathing pattern and ween if able. So what does that mean? If the baby is starting to breathe on their own, you can slowly pull that mask away and just give some blow-by oxygen to that baby so that way that will help correct any cyanosis. The baby’s breathing on its own, but you don’t want to just take that mask away cold turkey, right?You want to keep the oxygen on that baby and slowly move it away.

Let’s say the, after you’ve done these things, your heart rate is below 60. Then we’re going to go to the next step. If your heart rate is above 60, awesome. You just keep giving PPV or see CPAP on the baby. If the baby is breathing on its own but just needs a little extra oxygen. All right, so let’s see what this looks like when our heart rate is under 60. Alright, so heart rates assesses under 60. Everyone’s panicking, right? So we are going to do chest compressons and prepare to intubate and I mean not we as in the nurses, but the MD will be there. By this point you have called and you have the NICU team there, you have extra hands, they’re helping. The doctors kind of taking over here, making all the calls. So chest compressions are happening. PPV is continuing So it is three compressions to one breath. So one, and two and three and, breath. So to do this, let’s see if I can draw this.

All right, so here’s our chess line. There is our baby. Okay. So you are going to either be doing compressions by putting two fingers here and here right at the chest point. So it’s only two fingers cause we don’t need to have a whole ton of pressure on this little baby. So somebody will be doing the compressions with one and two and three and breathe one and two and three and breath. Another way and really the best way to do compressions is going to be to wrap the arms around. But obviously things kinda depends who’s in the way and how things are going. But if you can put your thumbs here and the rest of your hands are wrapped around.

The rest of your hands are wrapped around, but your thumbs are here. You’re going to compress right there. So one and two and three and breathe. All right, so that’s happening. And then we might be giving some epinephrine again by the doctor’s orders. So this will be either done IV or down the ET tube. If we’ve been successful with intubation, depending on what the provider wants.

All right, so let’s look at some key points here. So remember it’s an algorithm, but the first thing you got to do is you have to dry and stimulate for 30 seconds, no matter how badly you want to move on to the next step. This is what you need to do. Clear secretions, right? We need to have a clear airway because nobody can breathe with a big old hunk chunk of amniotic fluid down in their airway. So clear those secretions are out. Then we’re going to give some PPV. Then if the drying and stimulating doesn’t work then start compressions if the heart rate is under 60. And we need to do that. So PPV is our positive pressure ventilation. Remember and you are going to be monitoring oxygen saturation levels on that baby. You might need to increase the oxygen that you’re giving by the PPV based on that. Um, but again, the provider will be in there and be helping to guide the practice from there forward. All right guys. So our some concepts here, perfusion, oxygenation, obviously we are trying to actually make this baby fix profusion problems and then teamwork and collaboration because this is a huge group effort. When this happens, everyone jumps in all hands on deck. All right. I hope that keeps you kind of a brief overview of what NRP is and when you will use it. Now, go out and be your best selves today and as always, happy nursing.