NRP 7th Edition Materials: Where NRP is GoingNRP Current Issues Seminar

October 23, 2015 Washington, DC

Gary Weiner, MD, FAAPUniversity of Michigan, Ann Arbor, MI

Jeanette Zaichkin RN MN, NNP-BCTacoma 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• 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 instructorBeginning 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 instructor1. Possess a current NRP provider card for all lessons2. Apply online through the AAP3. Review Instructor Toolkit content and complete the online instructor

course4. Pass the NRP online instructor examination5. Designate an eligible NRP instructor mentor6. Co-teach 2 provider courses with your instructor mentor7. Participate in at least one “debrief the debriefer” session with your

instructor mentor

Online Instructor Toolkit• 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. Foundations2. Preparing for

Resuscitation3. Initial Steps of

Newborn Care4. Positive-pressure

Ventilation5. Alternative Airways6. Chest Compressions

7. Medications8. Post-resuscitation Care9. Resuscitation and

Stabilization of Babies Born Preterm

10. Special Considerations11. Ethics and Care at the

End of Life

• “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

New sections

Drawings replaced with color photos

What are the major changes in the NRP practice recommendations?

• Delay cord clamping for 30-60 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 nasal-tragus 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.”