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NRP Success: Essential Tips and Tricks for Neonatal Resuscitation
Welcome to Your Guide to Neonatal Resuscitation Program (NRP) Success!
This eBook is designed to empower you with the essential knowledge and skills needed to confidently manage a newborn's resuscitation needs. Through detailed explanations, actionable tips, and real-world examples, we’ll break down the key concepts, procedures, and critical considerations that form the foundation of neonatal resuscitation.
Whether you’re preparing for your NRP certification or looking to refine your clinical skills, this guide will serve as a valuable resource on your journey to success.n.
The MRSOPA Mnemonic: Explained
M - Mask
Ensure a proper fit and seal for optimal delivery of oxygen. Adjust mask size to fit the baby's face and avoid any leaks.
R - Reposition
Ensure the baby's airway is open by repositioning their head into a neutral or slightly extended "sniffing" position. Avoid overextending the neck, as this may obstruct the airway.
S - Suction
Clear the airway of any secretions or mucus. Use a bulb syringe or suction catheter, as appropriate.
O - Open the Airway
If the airway remains obstructed, use techniques such as suctioning the mouth and nose or gently opening the baby's mouth to improve airflow.
Mask Ventilation: Proper Technique and Troubleshooting
Proper Technique
Maintain a secure seal around the baby’s face with the mask, select the appropriate mask size, and gently tilt the baby’s head slightly back to open the airway.
Troubleshooting Tips
  • If chest rise is not observed, check for mask leaks, ensure a proper fit, and consider using a different mask size.
  • If resistance is encountered during ventilation, inspect the airway for potential obstructions.
Airway Management: Clearing Obstructions and Maintaining Patency
Obstruction Removal
Use a bulb syringe or suction catheter to gently clear secretions or mucus from the baby’s mouth and nose, ensuring the airway is unobstructed.
Maintaining Patency
Position the baby’s head in a neutral position to keep the airway open, avoiding hyperextension or flexion of the neck. If necessary, consider the use of a laryngeal mask airway (LMA) for effective airway management.
Positive Pressure Ventilation (PPV): Step-by-Step Initiation

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1. Prepare
Gather all necessary equipment, including a bag-valve-mask (BVM), oxygen source, and suction device. Ensure all devices are functional and readily accessible.
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2. Position
Place the baby in a supine position with the head gently tilted back to open the airway.
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3. Mask Placement
Secure the mask over the baby’s nose and mouth, ensuring a tight seal without excessive pressure.
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4. Ventilation
Deliver breaths using the BVM, observing for visible chest rise. Maintain a ventilation rate of 40–60 breaths per minute.
Assessing PPV Effectiveness: Key Parameters and Indicators
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1. Chest Rise
Observe for adequate chest rise with each ventilation.
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2. Heart Rate
Monitor heart rate for improvement and sustained levels. > 100 BPM
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3. Respiratory Rate
Assess for spontaneous breathing efforts and a stable respiratory rate.
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4. Oxygen Saturation
Aim for a saturation level of according to the NRP O2Sat chart
Neonatal Resuscitation Program (NRP) O2 Sats
The target oxygen saturation (SpO₂) levels for neonatal resuscitation as outlined in the Neonatal Resuscitation Program (NRP) guidelines vary by the baby's age in minutes after birth. These are the general SpO₂ targets to aim for:

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Minutes after birth: 60-65%
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Minutes after birth: 65-70%
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Minutes after birth: 70-75%
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Minutes after birth: 75-80%
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Minutes after birth: 80-85%
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Minutes after birth: 85-95%
Medications in Neonatal Resuscitation: Indications and Dosages
Epinephrine
Indicated for bradycardia or asystole, the dosage is 0.01-0.03 mg/kg IV or IO, repeated every 3-5 minutes as needed.
Sodium Bicarbonate
Used for severe metabolic acidosis, the dosage is 1 mEq/kg IV or IO, repeated as needed.
Surfactant
Administered for respiratory distress syndrome, the dosage is 100-200 mg/kg, administered intratracheally.
Naloxone
Used for opioid overdose, the dosage is 0.1 mg/kg IV or IO, repeated as needed.
Critical Considerations for Medication Administration
Dosage Accuracy
Use precise measurements to ensure the correct dosage is administered.
Route of Administration
Select the appropriate route, either IV, IO, or UVC.
Monitoring Vital Signs
Monitor the baby's vital signs closely after medication administration for any adverse effects.
Safe Handling
Always handle medications safely and dispose of them properly.
Equipment Setup and Readiness: The Essential Checklist

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Resuscitation Cart
Confirm all equipment is available and operational.
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BVM or NeoPuff
Test functionality and ensure an oxygen source is connected.
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Oxygen Source
Verify sufficient supply and correct flow rate.
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Suction Device
Check operation and ensure suction catheters are ready.
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Medications
Confirm availability, correct dosages, and expiration dates.
Case Scenario
Neonatal Resuscitation in the Delivery Room
Background:
A 28-year-old mother, gravida 2 para 1, is admitted for delivery at 35 weeks of gestation due to spontaneous preterm labor. The pregnancy was complicated by gestational diabetes and a lack of prenatal care during the last trimester. The mother tested positive for Group B Streptococcus (GBS) during early pregnancy, but no antibiotics were administered prior to delivery.
Delivery Details:
The infant is delivered via spontaneous vaginal delivery. Upon birth, the baby is limp, cyanotic, and apneic.
Send us your answer to the scenario above to studentquestions@morethancpr.com
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