nrp

1. NRP 2020 GUDELINES(AHA)
PRESENTER: DR.K.NAVANITHA REDDY
MODERATOR: DR.ARNAB SENGUPTA

4. WHAT QUESTIONS SHOULD YOU ASK BEFORE EVERY
BIRTH?

5.  What is the expected gestational age?
 Is the amniotic fluid clear?
 Are there any additional risk factors?
 Umbilical cord management plan? (previously it was how many babies?)

6. CLINICAL FINDINGS OF ABNOMAL TRANSITION
 Irregular or absent respiratory effort(apnea) or tachypnea
 Bradycardia or tachycardia
 Decreased muscle tone
 Low oxygen saturation
 Low blood pressure

7. Perinatal risk factors increasing the likelihood of neonatal resuscitation

12. IS DELAYED CORD CLAMPING RECOMMENDED ROUTINELY?
IF YES, LONGER THAN?

17. IS ROUTINE SUCTIONING RECOMMENDED OR NOT?

25. WHEN TO START CPR? WHICH IS THE PREFERRED
TECHNIQUE?

28. WHICH ROUTE IS PREFERRED FOR VASCULAR ACCESS?

37. SKIN TO SKIN CARE

38. Meconium stained liquor

39. VASCULAR ACCESS

40. DELAY UMBILICAL CORD CLAMPING
 Delay umbilical cord clamping for uncomplicated term and preterm neonates.
This allows the baby to be placed on the mother immediately, dried and
assessed for breathing, tone and activity. Other situations in which immediate
clamping and cutting of the cord can be deferred are described. New
research supports the 2015 position that umbilical cord milking is not
recommended for preterm infants
SUPPLEMENTAL OXYGEN
 Use supplemental oxygen judiciously

41. Termination of resuscitation

42. Maintaining skills

43. TOPICS REVIEWED WITH NO CHANGES OR ADDITION TO
PREVIOUS RECOMMENDATIONS
 Anticipation and Preparation
• Prediction of need of respiratory support in the delivery room
• Effect of briefing/debriefing following neonatal resuscitation
 Initial Assessment and Intervention
• Warming adjuncts
• Suctioning of clear fluid
 Physiological Monitoring and Feedback Devices
• Heart rate monitoring during neonatal resuscitation

44.  Ventilation and Oxygenation
• Sustained inflation
• Positive end-expiratory pressure (PEEP) versus no PEEP
• Continuous positive airway pressure (CPAP) versus intermittent PPV
• T-piece resuscitator versus self-inflating bag for ventilation
• Oxygen for preterm or term resuscitation (unchanged from 2019 focused
update)
 Circulatory Support
• CPR ratios for neonatal resuscitation
• 2-thumb versus 2-finger compressions for neonatal resuscitation

45.  Drug and Fluid Administration
• Volume infusion during neonatal resuscitation
• Sodium bicarbonate during neonatal resuscitation
 Post resuscitation Care
• Rewarming of hypothermic newborns
• Induced hypothermia in settings with limited resources
• Post resuscitation glucose management

46. SOURCES
 Aziz K, Le HC, Escobedo MB, et al. Part 5: Neonatal Resuscitation 2020
American Heart Association Guidelines for Cardiopulmonary Resuscitation
and Emergency Cardiovascular Care. Pediatrics. 2020;
doi: 10.1542/peds.2020-038505E. Accessed 10/22/2020
 Wyckoff MH, Weiner GM, et al. Neonatal Life Support 2020 International
Consensus on Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care Science With Treatment Recommendations. Pediatrics.
2020; doi: 10.1542/peds.2020-038505C . Accessed 10/22/2020

47. QUESTIONS?