1. NRP Review Newborn Nursery UF Health - Jacksonville

2. Term gestation? Breathing or crying? Good tone? Birth What 3 things should you be asking yourself walking into the delivery room?

3. Stay with mother Keep baby dry and warm Clear airway, if necessary Ongoing evaluation Birth Term gestation? Breathing or crying? Good tone? Yes

4. Warm, clear airway if necessary, dry, stimulate Birth Term gestation? Breathing or crying? Good tone? No

5. Birth 30 sec. HR below 100 bpm, gasping or apnea? 30 seconds have passed by. What is your next step?

6. 30 sec. 60 sec. If the baby’s HR is above 100 bpm, the baby is not gasping, and is not apneic, what is your next step? HR below 100 bpm, gasping or apnea? Labored breathing or persistent cyanosis? No Yes Clear airway S PO2 monitoring Consider CPAP

7. 30 sec. 60 sec. If the baby’s HR is below 100 bpm, the baby is gasping, or is apneic, what is your next step? HR below 100 bpm, gasping or apnea? Yes PPV, S PO2 monitoring

8. You are doing PPV but the HR remains below 100 bpm. What do you do next? Take ventilation corrective steps

9. List the 6 corrective steps to achieve adequate ventilation Corrective StepsActions MMask adjustmentBe sure there is a good seal of the mask on the face RReposition airwayThe head should be in the “sniffing” position SSuction mouth and noseCheck for secretions; suction if present OOpen mouthVentilate with the baby’s mouth slightly open and lift the jaw forward PPressure increaseGradually increase the pressure every few breaths, until there are bilateral breath sounds and visible chest movement with each breath AAirway alternativeConsider endotracheal intubation or laryngeal mask airway

10. You have taken corrective steps. You have now given 30 seconds of effective PPV but the HR remains below 60 bpm. What should you do next? HR below 60 bpm? Yes Consider intubation Chest compressions Coordinate with PPV

11. What is the appropriate ratio of compressions to ventilation? 3 compressions to 1 ventilation. In one minute, there should be 90 compressions plus 30 breaths. When do you stop chest compressions? When the heart rate is greater than 60 bpm.

12. After 45-60 seconds of chest compressions and coordinated PPV, a team member rechecks the HR and it remains below 60 bpm. HR below 60 bpm? Yes Take ventilation corrective steps Intubate if no chest rise! HR below 60 bpm? Consider: Hypovolemia Pneumothorax IV Epinephrine Concentration: 1:10,000 Dose: 0.1-0.3 mL/kg Consider intubation Chest compressions Coordinate with PPV

13. You are about to intubate. How do you determine what size endotracheal (ET) tube is correct? Gestational Age (weeks) Weight (kg)ET Tube Size (ID, mm) Depth of insertion* (cm from upper lip) < 28< 1.02.56-7 28-341.0-2.03.07-8 34-382.0-3.03.58-9 > 38> 3.03.5-4.09-10 * Depth of insertion (cm) = 6 + weight (in kg)

14. How long after the dose of epinephrine should you wait before re-checking the heart rate? 1 minute While you wait, you are continuing to give PPV and chest compressions.

15. During a resuscitation, you should be monitoring the infant’s oxygen saturation. Should this measurement be preductal or postductal? Preductal (RUE). What is the target preductal saturation at the following time intervals? 1 min 2 min 3 min 4 min 5 min 10 min 60%-65% 65%-70% 70%-75% 75%-80% 80%-85% 85%-90%