The Indian Journal of Pediatrics

, Volume 81, Issue 5, pp 473–480 | Cite as

The Neonatal Resuscitation Program: Current Recommendations and a Look at the Future

  • Praveen Kumar
  • Nicole K. Yamada
  • Janene H. Fuerch
  • Louis P. Halamek


The Neonatal Resuscitation Program (NRP) consists of an algorithm and curriculum to train healthcare professionals to facilitate newborn infants’ transition to extrauterine life and to provide a standardized approach to the care of infants who require more invasive support and resuscitation. This review discusses the most recent update of the NRP algorithm and recommended guidelines for the care of newly born infants. Current challenges in training and assessment as well as the importance of ergonomics in the optimization of human performance are discussed. Finally, it is recommended that in order to ensure high-performing resuscitation teams, members should be selected and retained based on objective performance criteria and frequent participation in realistic simulated clinical scenarios.


Neonatal resuscitation program Training Assessment Ergonomics Simulation Human performance 



All authors participated in literature review, drafting the manuscript and have reviewed and approved the manuscript. Praveen Kumar will act as guarantor for this paper.

Conflict of Interest


Role of Funding Source



  1. 1.
    Lawn JE, Kerber K, Enweronu-Laryea C, Cousens S. 3.6 million neonatal deaths--what is progressing and what is not? Semin Perinatol. 2010;34:371–86.PubMedCrossRefGoogle Scholar
  2. 2.
    Lee AC, Cousens S, Wall SN, Niermeyer S, Darmstadt GL, Carlo WA, et al. Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths: A systematic review, meta-analysis and Delphi estimation of mortality effect. BMC Public Health. 2011;11:S3–12.Google Scholar
  3. 3.
    Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med. 2008;358:700–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Neonatal Resuscitation Program: 20th Anniversary 1987–2007. Last accessed on 10/09/2013.
  5. 5.
    International Liaison Committee on Resuscitation (ILCOR). Last accessed on 10/09/2013.
  6. 6.
    Perlman J, Kattwinkel J, Wyllie J, Guinsburg R. Velaphi S; Nalini Singhal for the Neonatal ILCOR Task Force Group. Neonatal resuscitation: In pursuit of evidence gaps in knowledge. Resuscitation. 2012;83:545–50.PubMedCrossRefGoogle Scholar
  7. 7.
    Perlman JM, Wyllie J, Kattwinkel J, Atkins DL, Chameides L, Goldsmith JP, et al. Neonatal Resuscitation Chapter Collaborators. Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics. 2010;126:e1319–44.PubMedCrossRefGoogle Scholar
  8. 8.
    Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J, et al. Part 15: Neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:S909–9.PubMedCrossRefGoogle Scholar
  9. 9.
    American Academy of Pediatrics, American Heart Association. Textbook of Neonatal Resuscitation. 6th ed. Dallas (TX): Elk Grove Village (IL); 2011.Google Scholar
  10. 10.
    Vain NE, Szyld EG, Prudent LM, Wiswell TE, Aguilar AM, Vivas NI. Oropharyngeal and nasopharyngeal suctioning of meconium stained neonates before delivery of their shoulders: Multicentre, randomised controlled trial. Lancet. 2004;364:597–602.Google Scholar
  11. 11.
    Altuncu E, Ozek E, Bilgen H, Topuzoglu A, Kavuncuoglu S. Percentiles of oxygen saturations in healthy term newborns in the first minutes of life. Eur J Pediatr. 2008;167:687–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Kamlin CO, O’Donnell CP, Davis PG, Morley CJ. Oxygen saturation in healthy infants immediately after birth. J Pediatr. 2006;148:585–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Mariani G, Dik PB, Ezquer A, Aguirre A, Esteban ML, Perez C, et al. Pre-ductal and post-ductal O2 saturation in healthy term neonates after birth. J Pediatr. 2007;150:418–21.PubMedCrossRefGoogle Scholar
  14. 14.
    Rabi Y, Yee W, Chen SY, Singhal N. Oxygen saturation trends immediately after birth. J Pediatr. 2006;148:590–4.PubMedCrossRefGoogle Scholar
  15. 15.
    O'Donnell CP, Kamlin CO, Davis PG, Carlin JB, Morley CJ. Clinical assessment of infant colour at delivery. Arch Dis Child Fetal Neonatal Ed. 2007;92:F465–7.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Rabi Y, Rabi D, Yee W. Room air resuscitation of the depressed newborn: A systematic review and meta-analysis. Resuscitation. 2007;72:353–63.PubMedCrossRefGoogle Scholar
  17. 17.
    Escrig R, Arruza L, Izquierdo I, Villar G, Saenz P, Gimeno A, et al. Achievement of targeted saturation values in extremely low gestational age neonates resuscitated with low or high oxygen concentrations: A prospective, randomized trial. Pediatrics. 2008;121:875–81.PubMedCrossRefGoogle Scholar
  18. 18.
    Hillman NH, Moss TJ, Kallapur SG, Bachurski C, Pillow JJ, Polglase GR, et al. Brief, large tidal volume ventilation initiates lung injury and a systemic response in fetal sheep. Am J Respir Crit Care Med. 2007;176:575–81.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Polglase GR, Hooper SB, Gill AW, Allison BJ, McLean CJ, Nitsos I, et al. Cardiovascular and pulmonary consequences of airway recruitment in preterm lambs. J Appl Physiol. 2009;106:1347–55.PubMedCrossRefGoogle Scholar
  20. 20.
    Hussey SG, Ryan CA, Murphy BP. Comparison of three manual ventilation devices using an intubated mannequin. Arch Dis Child Fetal Neonatal Ed. 2004;89:F490–3.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Trevisanuto D, Micaglio M, Pitton M, Magarotto M, Piva D, Zanardo V. Laryngeal mask airway: Is the management of neonates requiring positive pressure ventilation at birth changing? Resuscitation. 2004;62:151–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Gandini D, Brimacombe JR. Neonatal resuscitation with the laryngeal mask airway in normal and low birth weight infants. Anesth Analg. 1999;89:642–3.PubMedGoogle Scholar
  23. 23.
    Esmail N, Saleh M, Ali A. Laryngeal mask airway versus endotracheal intubation for Apgar score improvement in neonatal resuscitation. Egyptian J Anesthesiol. 2002;18:115–21.Google Scholar
  24. 24.
    Aziz HF, Martin JB, Moore JJ. The pediatric disposable end-tidal carbon dioxide detector role in endotracheal intubation in newborns. J Perinatol. 1999;19:110–3.PubMedCrossRefGoogle Scholar
  25. 25.
    Garey DM, Ward R, Rich W, Heldt G, Leone T, Finer NN. Tidal volume threshold for colorimetric carbon dioxide detectors available for use in neonates. Pediatrics. 2008;121:e1524–27.PubMedCrossRefGoogle Scholar
  26. 26.
    Lane B, Finer N, Rich W. Duration of intubation attempts during neonatal resuscitation. J Pediatr. 2004;145:67–70.PubMedCrossRefGoogle Scholar
  27. 27.
    O'Donnell CP, Kamlin CO, Davis PG, Morley CJ. Endotracheal intubation attempts during neonatal resuscitation: Success rates, duration, and adverse effects. Pediatrics. 2006;117:e16–21.Google Scholar
  28. 28.
    SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network, Finer NN, Carlo WA, Walsh MC, Rich W, Gantz MG, Laptook AR, et al. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med. 2010;362:1970–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Menegazzi JJ, Auble TE, Nicklas KA, Hosack GM, Rack L, Goode JS. Two-thumb versus two-finger chest compression during CRP in a swine infant model of cardiac arrest. Ann Emerg Med. 1993;22:240–3.PubMedCrossRefGoogle Scholar
  30. 30.
    Houri PK, Frank LR, Menegazzi JJ, Taylor R. A randomized, controlled trial of two-thumb vs two-finger chest compression in a swine infant model of cardiac arrest. Prehosp Emerg Care. 1997;1:65–7.Google Scholar
  31. 31.
    Mielke LL, Frank C, Lanzinger MJ, Wilhelm MG, Entholzner EK, Hargasser SR, et al. Plasma catecholamine levels following tracheal and intravenous epinephrine administration in swine. Resuscitation. 1998;36:187–92.PubMedCrossRefGoogle Scholar
  32. 32.
    Roberts JR, Greenberg MI, Knaub MA, Kendrick ZV, Baskin SI. Blood levels following intravenous and endotracheal epinephrine administration. JACEP. 1979;8:53–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Ringer SA, Aziz K. Neonatal stabilization and postresuscitation care. Clin Perinatol. 2012;39:901–18.PubMedCrossRefGoogle Scholar
  34. 34.
    Halamek LP. The rationale and strategy for rigorous human performance assessment in neonatal-perinatal medicine. In press. Neo Reviews. 2013.Google Scholar
  35. 35.
    Halamek LP. Simulation as a methodology for assessing the performance of healthcare professionals working in the delivery room. Semin Fetal Neonatal Med. 2013;18:369–72.PubMedCrossRefGoogle Scholar
  36. 36.
    Halamek LP. The simulated delivery-room environment as the future modality for acquiring and maintaining skills in fetal and neonatal resuscitation. Semin Fetal Neonatal Med. 2008;13:448–53.PubMedCrossRefGoogle Scholar
  37. 37.
  38. 38.
    Halamek LP. Simulation in neonatal-perinatal medicine. In: Fanaroff AA, Martin RJ, eds. Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 10 ed. St. Louis, MO: Mosby Year Book; 2013. In press.Google Scholar
  39. 39.
    Walsh T, Beatty PCW. Human factors errors and patient monitoring. Physiol Meas. 2002;23:R111–32.PubMedCrossRefGoogle Scholar
  40. 40.
    Gosbee J. Human factors engineering and patient safety. Qual Saf Health Care. 2002;11:352–4.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Gawron VJ, Drury CG, Fairbanks RJ, Berger RC. Medical error and human factors engineering: Where are we now? Am J Med Qual. 2006;21:57–67.PubMedCrossRefGoogle Scholar
  42. 42.
    Finer NN, Rich W, Halamek LP, Leone TA. The delivery room of the future: The fetal/neonatal resuscitation and transition suite. Clin Perinatol. 2012;39:931–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Kumar P, Halamek LP. Resuscitation of the newborn. Clin Perinatol. 2012;39:xv–xvi.PubMedCrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2014

Authors and Affiliations

  • Praveen Kumar
    • 1
  • Nicole K. Yamada
    • 2
  • Janene H. Fuerch
    • 2
  • Louis P. Halamek
    • 2
  1. 1.Division of Newborn Medicine, Department of PediatricsBatson Children’s Hospital, The University of Mississippi Medical CenterJacksonUSA
  2. 2.Division of Neonatal and Developmental Medicine, Department of PediatricsStanford University School of MedicinePalo AltoUSA

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