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BACKGROUND

KEY QUESTIONS

  • What are the steps recommended by the Neonatal Resuscitation Program (NRP) that you need to know?

  • What are the changes to the seventh edition of the NRP compared to the previous edition, and the rationale for such changes?

  • What are the maternal risk factors that may be associated with the need for neonatal resuscitation?

  • What personnel should be present at delivery?

  • What are common mistakes, as opposed to learning mistakes?

CASE 40-1

A 35 y.o. G2P0 homeless woman admitted at 36 weeks gestation due to preeclampsia and oligohydramnios. She was complaining of feeling cramps from the back that radiated to the front every 2 to 3 minutes. Fetal movements were reported. External fetal heart monitoring was put in place and showed a Category II pattern. The patient then stated, “I am ready to push.” She was instructed to breathe and lie on her left side. Vaginal exam was C/C/+1, the patient spontaneously ruptured her membranes, the fluid was meconium-stained, and birth was imminent. The LD nurse called the NICU team to attend a stat delivery. The baby was born blue with poor tone, not breathing and not crying.

What should be the first goal? The three questions on the diagram may guide the next steps. Clear closed loop communication is essential as tasks are simultaneously assigned to the different members of the team from the newborns vital signs, 3 lead EKG placement to the actual timing of interventions provided.

The Neonatal Resuscitation Program (NRP) will help you learn the cognitive, technical, and teamwork skills that you need to resuscitate and stabilize newborns. Although most newborns make the cardiorespiratory transition to extrauterine life without intervention, many require assistance to begin breathing, and a small number of them require extensive intervention. After birth, approximately 4% to 10% of term and late-preterm newborns will receive positive pressure ventilation (PPV), while only 1 to 3 per 1000 will receive chest compressions or emergency medications. Because the need for assistance cannot always be predicted, teams need to be prepared to provide these lifesaving interventions quickly and efficiently at every birth.1

PATHOPHYSIOLOGY

In an adult, cardiac arrest is most often a complication of trauma or existing heart disease. It is caused by a sudden arrhythmia that prevents the heart from effectively circulating blood. As circulation to the brain decreases, the adult victim loses consciousness and stops breathing. At the time of arrest, the oxygen and carbon dioxide (CO2) content of blood is usually normal. During adult cardiopulmonary resuscitation (CPR), chest compressions are used to maintain circulation until electrical defibrillation or medications restore cardiac function.1 In contrast, most newborns requiring CPR have a healthy heart. When a newborn requires resuscitation, it is usually caused by a problem with respiration leading to inadequate gas exchange.1

Respiratory failure may occur either before or after birth. Before birth, fetal ...

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