Lesson 1, Neonatal Resuscitation, American Academy of Pediatrics

1. Overview and Principles of Resuscitation
28
Lesson 1: Equipment Check
Performance Checklist
NRP
Term gestation?
Breathing or crying?
Good tone?
No
Warm, clear airway if necessary,
dry, stimulate
Yes—stay
with mother
HR below 100 bpm,
gasping, or apnea?
Labored
breathing
or persistent
cyanosis?
No
No
PPV,
Yes
SPO2 monitoring
Clear airway
SPO2 monitoring
Consider CPAP
Post-resuscitation
care
Targeted Pre-ductal SPO2
After Birth
1 min
2 min
3 min
4 min
5 min
10 min
60-65%
65-70%
70-75%
75-80%
80-85%
85-95%
Yes
HR below 100 bpm?
Yes
HR below 60 bpm?
Yes
Consider intubation
Chest compressions
Coordinate with PPV
IV epinephrine
No
Birth
30 sec
60 sec
No
Take ventilation
corrective steps
HR below 60 bpm?
Routine Care
• Provide warmth
• Clear airway if necessary
• Dry
• Ongoing evaluation
Yes
The Performance Checklist Is a Learning Tool
The learner uses the checklist as a reference during independent
practice, or as a guide for discussion and practice with a Neonatal
Resuscitation Program (NRP) instructor. When the learner and
instructor agree that the learner can perform the skills correctly and
smoothly without coaching and within the context of a scenario, the
learner may move on to the next lesson’s Performance Checklist.
This Equipment Check Performance Checklist includes only the most
essential supplies and equipment for neonatal resuscitation. You may
wish to add supplies or additional safety checks to meet your unit’s
standards or protocols. When the learner knows the routine and
supplies are present and functioning, the Equipment Check should take
approximately 1 minute to complete.

2. L E S S O N 1
29
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 high-risk?
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 Details
Warm:
Preheat warmer
Lay out towels or blankets
Learner begins with equipment
needed for initial steps of
resuscitation and ends with
equipment needed for complex
resuscitation.
Clear the airway 3 ways:
Bulb syringe
10F or 12F suction catheter
attached to wall suction, set at
80-100 mm Hg
Meconium aspirator
Turns on wall suction to “continuous”
and occludes suction tubing; adjusts
suction to 80-100 mm Hg.
Auscultate
Stethoscope
Picks up stethoscope, places in ears,
and taps on diaphragm to ensure
function.

3. Overview and Principles of Resuscitation
30
Performance Steps Details
Oxygenate
Turn on oxygen flowmeter to
5-10 L/min
Adjust blender to hospital
standard for initiation of
resuscitation
Pulse oximeter probe
Pulse oximeter
If birth is imminent, suction and air/
oxygen should be turned on and
ready for use.
Are air/O2 tanks full, if used in your
setting?
Safety Check: Even if beginning
resuscitation with 21% oxygen, the
air/oxygen flow should be turned on
in the event that supplemental
oxygen is needed. A self-inflating bag
will work even without gas flow;
therefore, turn on air/oxygen so that
gas is flowing if blender is turned up
to administer supplemental oxygen.
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
It is most important to check that
safety features are working to prevent
over-inflation of lungs with PPV.
Manometers present and
functioning? Connected to
oxygen/air?
Self-inflating bag: Pop-off valve
working?
Flow inflating bag: Does it inflate
properly (no rips or missing
attachments)?
T-piece: Maximum circuit pressure set
appropriately? Peak inspiratory
pressure and positive end-expiratory
pressure set appropriately?
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
Learner should know how to attach
and detach blade from laryngoscope;
check laryngoscope light.
If setting up for intubation, ET tube
should stay clean inside its package
even if package is open and stylet is
inserted.
Medicate
Access to
1:10,000 epinephrine
Supplies for administering
medications and placing
emergency umbilical venous
catheter
Documentation supplies
Location and protocol for checking
emergency medications and supplies
for vascular access are specific to
each birth unit.

4. L E S S O N 1
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Performance Steps Details
Thermoregulate
For very preterm newborns
Plastic wrap or bag
Chemically activated warming
pad
Transport incubator
Other
Unit-specific items
These items may be specific to your
unit.
Tailor the Equipment Checklist to
meet facility requirements.
Instructor asks the learner Reflective Questions to enable self-assessment,
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. Allocate attention wisely.
Anticipate and plan. Use all available information.
Assume the leadership role. Use all available resources.
Communicate effectively. Call for help when needed.
Delegate workload optimally. Maintain professional behavior.