NRP 7th Edition Materials: Where NRP is Going
NRP Current Issues Seminar
October 23, 2015
Washington, DC
Gary Weiner, MD, FAAP
University of Michigan, Ann Arbor, MI
Jeanette Zaichkin RN MN, NNP-BC
Tacoma WA
Faculty Disclosure Information
In the past 12 months, we have no relevant financial relationships with the
manufacturer(s) of any commercial product(s) and/or provider(s) of
commercial services discussed in this CME activity.
• We are compensated editors and consultants for the American Academy
of Pediatrics/NRP and, as such, have contractual relationships to produce
AAP/Laerdal co-branded educational materials
• We receive no financial benefit from the sale of these materials
We do NOT intend to discuss an unapproved/investigative use of a
commercial product/device in this presentation.
Session Objectives
• Discuss changes to the requirements for achieving Provider
status
• Describe how eSimulation integrates into 7th edition NRP
• Describe changes in the path to becoming an instructor
• Identify improvements for NRP instructors and providers in
the new database
• Discuss changes to the structure of the 7th edition textbook
• Identify major changes in resuscitation practice
How to achieve Provider status
• Self-study the textbook as needed
• Pass the online examination (all 11 lessons)
• Complete at least 3 online eSimulation practice
scenarios
• Meet the objectives of the in-person Provider
course
eSimulation
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•
What it is
Anyone can do it
Learning experience, not testing
After accessing eSimulation for Provider
status, you may access scenarios for practice
anytime
Path to becoming an instructor
Beginning January 1, 2017 NRP instructor candidates must
• be physicians, registered nurses, respiratory care practitioners,
or physician assistants with experience in the hospital care of
newborns in the delivery room
• have current maternal-child educational or clinical
responsibility within a hospital setting
It is recommended that NRP instructors and instructor candidates
have ongoing delivery room experience.
Path to becoming an instructor
1.
2.
3.
4.
5.
6.
7.
Possess a current NRP provider card for all lessons
Apply online through the AAP
Review Instructor Toolkit content and complete the online
instructor course
Pass the NRP online instructor examination
Designate an eligible NRP instructor mentor
Co-teach 2 provider courses with your instructor mentor
Participate in at least one “debrief the debriefer” session with
your instructor mentor
Online Instructor Toolkit
•
•
•
•
•
•
•
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All instructional resources in one location (keyword searchable)
Replaces the NRP Instructor Manual
No NRP Instructor DVD to purchase
No additional fee to access the instructor course, eSimulation, and the
online examination for instructors (includes continuing education credits)
A webinar for NRP instructor mentors available anytime
Downloadable PDFs of most commonly used documents and checklists for
use in NRP Provider courses
Podcasts by neonatal resuscitation experts
Continuously updated educational materials and new resources
throughout the life of the 7th Edition
The new NRP Database and Learning
Management System
• Launching with NRP 7th edition materials in
Spring 2016
• Course registration, completion history and
educational resources (eg, online examination,
eSimulation, instructor resources) in one place.
• Can access/e-mail eCard at any time
What’s new about the textbook’s
structure?
1. Foundations
2. Preparing for
Resuscitation
3. Initial Steps of
Newborn Care
4. Positive-pressure
Ventilation
5. Alternative Airways
6. Chest Compressions
7. Medications
8. Post-resuscitation
Care
9. Resuscitation and
Stabilization of Babies
Born Preterm
10. Special Considerations
11. Ethics and Care at the
End of Life
New sections
• “Focus on Teamwork”
– Integrates emphasis on teamwork
and communication with lesson
content
• “Frequently Asked Questions”
– Controversies and questions
commonly sent to the NRPSC
• “Ethical considerations”
– Highlight questions to consider in
context of lesson content
Drawings replaced with color photos
What are the major changes in the
NRP practice recommendations?
• Delay cord clamping for 3060 seconds for most term
and preterm newborns
– Place skin-to-skin with mom
• No delay if placental
circulation disrupted
(abruption, avulsion)
• Insufficient evidence re:
timing if baby is not vigorous
Time of birth is still the
time when the baby
emerges from its mother,
not the time of cord
clamping…
Routine tracheal suction no
longer recommended for
NON-VIGOROUS babies
with meconium stained fluid
– MSAF is a risk factor that
requires presence of a
team member with
intubation skill
Initial HR assessed by
auscultation
– Palpation of the
umbilical cord is less
reliable and less
accurate
Initial HR assessed by
auscultation
• PPV begins, consider
electronic cardiac monitor
• Resuscitation anticipated
or chest compressions
begin, electronic cardiac
monitor is preferred
method
Initial FiO2 for PPV
•  35 weeks’ GA = 21%
• < 35 weeks’ GA = 21-30%
PPV Steps Clarified
Intubation
• Strongly recommended
before starting chest
compressions
• Estimate tip-to-lip distance
with new table or nasaltragus length (NTL)
Nasal-Tragus Length
Compressions
• Use 2-thumb technique
• Head-of-bed compressions
• Cardiac monitor
recommended
• Continue for 60 seconds
prior to checking a heart
rate.
Medications
• Only 2 medications to
remember
– Epinephrine
• IV or IO preferred
• ET x 1 while achieving
intravascular access
– Normal saline
Preterm
• Less than 32 weeks’ gestation
– Without drying, cover in food-grade
plastic wrap or bag and use a hat and
thermal mattress
– Use a 3-lead cardiac monitor (chest or
limb leads) for rapid and reliable
continuous HR
• If PPV, use a device with PEEP
• Consider CPAP immediately after
birth as an alternative to routine
intubation and surfactant
administration.
Increased Emphasis
• Teamwork
• Preparation before
resuscitation
– Structured check of equipment
and supplies
– Identifying roles
• Accurate documentation
What hasn’t changed?
Veni, Venti, Vici
“Ventilation of the lungs is
the single most important
and most effective step in
cardiopulmonary
resuscitation of the
compromised newborn.”