The Neonatal Resuscitation Program® (NRP®) course conveys an evidence-based approach to care of the newborn at birth and facilitates effective team-based care for healthcare professionals who care for newborns at the time of delivery.
However, if attempted intubation is prolonged and unsuccessful, bag-mask ventilation should be considered, particularly if there is persistent bradycardia.
There is a large body of evidence that blood oxygen levels in uncompromised babies generally do not reach extrauterine values until approximately 10 minutes following birth.
With careful consideration of risk factors, the majority of newborns who will need resuscitation can be identified before birth.
If the possible need for resuscitation is anticipated, additional skilled personnel should be recruited and the necessary equipment prepared.
Either that person or someone else who is promptly available should have the skills required to perform a complete resuscitation, including endotracheal intubation and administration of medications.
Several studies have demonstrated that a cesarean section performed under regional anesthesia at 37 to 39 weeks, without antenatally identified risk factors, versus a similar vaginal delivery performed at term, does not increase the risk of the baby requiring endotracheal intubation.
Assessment of heart rate should be done by intermittently auscultating the precordial pulse.
When a pulse is detectable, palpation of the umbilical pulse can also provide a rapid estimate of the pulse and is more accurate than palpation at other sites.
Suctioning of the oropharynx before delivery of the shoulders was considered routine until a randomized controlled trial demonstrated it to be of no value.
Elective and routine endotracheal intubation and direct suctioning of the trachea were initially recommended for all meconium-stained newborns until a randomized controlled trial demonstrated that there was no value in performing this procedure in babies who were vigorous at birth.
A pulse oximeter can provide a continuous assessment of the pulse without interruption of other resuscitation measures, but the device takes 1 to 2 minutes to apply, and it may not function during states of very poor cardiac output or perfusion.