The document outlines the Neonatal Resuscitation Program (NRP) presented by Manisha Thakur, emphasizing the transition of newborns from intra-uterine to extra-uterine life, and the need for immediate assessment and intervention if the baby is not breathing properly. It details key risk factors, essential equipment, and specific resuscitation steps including airway management, positive pressure ventilation, and chest compressions. The program also stresses the importance of post-resuscitation care and monitoring in a neonatal intensive care unit.

1. NEONATAL
RESUSCITAION
PROGRAM
Presented by:
Manisha Thakur
Nursing Tutor

2. NEONATAL RESUSCITATION
PROGRAM
 When the baby is inside uterine the fetus get all
nutrition from the mother through the umbilical
cord attached to placenta
 When the baby is born, the baby is transiting from
intra-uterine environment to extra-uterine
environment. We need to make sure that the
baby is well adjusting to its outer environment i.e.
the baby is crying, taking normal breaths and
have normal range of heart rate.
 but if the baby is not able to breath properly in its
extra-uterine environment, this might lead to brain
death as the oxygen is not reaching to its vital
organ.

3. Preparation of resuscitation
 Risk factors: history: prenatal and intranatal can
give a knowledge wether baby may require
extensive resuscitaion .
 Allow the health care team to be better prepared .
Prenatal risk factor Intranatal risk factor
Preeclampsia/ eclampsia Emergency cesareamn section
IUGR Forcep/vaccum delivery
Polyhydramnios Breech abnormal presentation
Fetal hydrop Intrapartum bleeding
Olighydramnios Shoulder dystoocia
Fetal macrosomia chorioamnionitis

4. GOLDEN ONE
MINUTE
If the child is not able to breath properly in this first
minute of his/her life
Then the health care professional should help him/her to
initate the breath or facilitate in taking breath so , that
there is not limitation of oxygen in the baby body
NEONATAL RESUSCITATION PROGRAM

5. ARTICLES REQUIRED FOR
NRP
Articles Quatity
Radiant warmer
cap, plastic wrap
Neopuff 1
Oxygen blender
2 Bed sheet/ towels 2
Shoulder roll 1
Bulb syringe
Term/preterm mask
Pulse oxymeter
Stethoscope

6. Quantity
Ambu bag 1 To provide PPV
Laryngoscope 1 To visulalize larynx for intubation
Endotracheal tube 2.5,
3.0, 3.5
Syringes 1 To provide medication
Cutting blade 1 To cut cord
Sticking tape 1 To fix ET
Feeding tube 1 To suction the nose and mouth
Suction catheter 1 To suction the nose and mouth
Central line tray 1 For central line catherization
Umblical line 1 For umblical catherization
Cord clamp 1 To clamp cut cord
Vitamin K injection 1 To prevent bleeding in new born
Inj adrenaline 1 To increase HR
Normal saline 1 For suctioning and dilution with medication

7. BEFORE DELIVERY
1. Anticipate
2. Counseling of parents
3. ROLE ASSIGNMENT IN PARENTS
(airway, chest compressions, IV and
time keeping)
4. Keep instrument ready (radiant
warmer: instruments)

8.  The radiant warmer and keep it on manual mode
and bed sheet which is there should be warm too
(as cold bed sheet can cause the hypothermia).
 Receive the baby with gloved hand in the radiant
warmer and receive the baby in the warm bed-
sheet.
 As soon as we receive baby we need to see baby
for three things:
1. Gestation al age ( full/ preterm)
2. Crying or not
3. Tone is good or not.

9.  If answer is yes, the routine care should be given
Routine
care
Dry the baby
Maintain
temperature.
Airway
maintain
Cord
clamping
delayed for
30 secs.
Breastfeed
as soon as
possible

10.  If answer is NO, the routine care should be given
 Cord should be clamped.
 The baby is moved under radiant warmer.
 The baby is managed according to resuscitation
algorithim.

11. Clean the baby under radiant warmer
& clean
Sniffing position: shoulder roll
Tickle feet and rub back
Suctioning: oral followed by
nasal. Oral 5cm and nasal
2cm . Pressure: 100 cm of
water

12. Initial
steps
Maintain
temperature
Position
Clear airway
Dry and
stimulate
• Normal temp: 36.5 C
-37.5 C.
• Radiant warmer
• Use of plastic wrap.
• Immediate drying of
babyc
• Supine position with
head in midline and
neck slight extention
(sniffing position.
• Shoulder roll is kept
under shoulder.
• Mouth is suction
before nose.
• Dried using
prewarmed sheet.
• <32 weeks wrapped
in plastic wrap.
• Babys back, neck,
trunk are rubbed
gently.

13. Spo2 probe attach on right hand(it is
preductal saturation and spo2 of rt hand
is equal to spo2 of blood delivered to
brain)
ECG is attached.
Positive pressure ventilation: (bag &
mask): stand at head end: look for chest
rise(evaluate in 5 cycles … breath
23..breath 23)

14. POSITIVE PRESSURE
VENTILATION
 Self inflating bag (250-750 ml) is the most
commonly devise used.
 The PPV forces gas into the lungs with some
additional pressure which opens up the collapsed
alveoli and hence improved oxygenation.
 The pressure
• preterm- 20-25 cmh2o
• Term – 20-40 cm h2o

15.  If the chest is ot movig with each reath and there are
poor breath sounds, ventilation corrective steps are
taken.
 Causes for ineffective ventilation:
1. Inadequate mask seal
2. Blocked airway
3. Inadequate pressure
MR SOPA

16. Ventilation corrective steps
M Mask adjustment Reapply the mask. Consider
using two hand technique
R Reposition airway Place head in sniffing position.
S Suction Use bulb syringe or suction catheter
O Open airway Open the mouth and lift the jaw
forward
P Pressure increase Increase pressure in 5-10cm H2O,
max. 40 cm H2o
A Alternate airway Place endotracheal tube or
laryngeal mask airway

17. Correct position of head ad neck to keep the
airway open.

18. Appropriate sized mask. The mask should cover the
nose ad the mouth but not the eyes

19. Evaluate for 30 secs.
HR more than 100 – stop bag and
mask
HR less than 100 but more than 60-
continue bag & mask
HR less than 60- start chest
compression
Chest compression: 3:1 i.e. 3
compression and 1 breath ( chest
compression should be 1&2&3&
breath, & helps for chest recoil)
Method : two finger compression
Arms around method( done at below
nipple line, at xiphi sternum)
Compress 1/3rd of anterio posterior
diameter
Chest
compress
ion for 1
min

20. THINGS TO REMEMBER WHILE
GIVING CHEST COMPRESSION
 Chest compression should be started if HR remains below 60b/m
after 30 mins of PPV.
 3:1 compression to ventilation.
 120 events each minute(90 compression : 30 ventilation)
Chest compression at lower third sternum.
Chest wall compression around one third of anterio
posterior dia. Of chest
Proper coordination between compression and
ventilation 3:1
Allow reexpansion of chest, but thumb should not be
raised

21. Techniques of chest compression
Nipple line
Compression
area
xiphoid
Two thumb technique Two finger technique

22. Two thumb technique Two finger method
Compressions are delivered with 2
thumbs, and the fingers encircle the
chest while supporting the back
Compressions are delivered by 2
fingers while hand supports the
back.
This is preferred technique as it
generates higher blood pressure
and coronary perfusion with lesser
rescuer fatigue.

23.  Continue chest compression while giving
adrenaline and always flush after giving
adrenaline.
 Evaluate after one min whether HR is above 60
or not
 If HR remains below 60: repeat dose of
adrenaline. Continue intubation if not already
done and rule out pneumothorax or
hypervolemia.

24.  Adrenaline : increases muscles strenght and
cardiac contractility, increases peripheral
vasoconstriction.
Drug Route Dose (ml/kg) Administration
Epinephrine
(1:10000)
Intravenous 0.1-0.3 Flush with 0.5-1
ml of N/S
Intraosseous 0.1-0.3 Flush with 0.5-1
ml of N/S
Endotracheal o.5-1 PPV breaths to
distribute into
lungs

25. Post resuscitative care
 Once the ventilation and circulation are
established, the infant should be transferred to
intensive care unit and kept under close
observation.
 Monitoring and maintaining normal glucose level
 Temperature maintanenace.
 Shift to mother site.