Neonatal Resuscitation Algorithm flowchart: NRP

This is a Neonatal Resuscitation Algorithm flowchart, specifically the NRP (Neonatal Resuscitation Program), published by the AHA in 2020. It provides a step-by-step guide for healthcare providers to follow during the resuscitation of a newborn immediately after birth, focusing on stabilizing the infant’s breathing, heart rate, and oxygenation.

Starting Point

• Antenatal Counseling and Team Briefing: Before birth, the team prepares and checks equipment.

• Birth: The process begins at the moment of birth.

Initial Assessment (Within the First Minute)

1 Term Gestation? Good Tone? Breathing or Crying?

◦ If Yes: The infant stays with the mother for routine care (warming, maintaining normal temperature, positioning airway, clearing secretions if needed, drying, and ongoing evaluation).

◦ If No: Proceed to resuscitation steps.

2 Apnea or Gasping? HR Below 100/min?

◦ If Yes:

▪ Start PPV (Positive Pressure Ventilation) using a SpO₂ monitor and consider an ECG monitor.

▪ Check if the heart rate (HR) is still below 100/min after PPV.

◦ If No:

▪ Check for Labored Breathing or Persistent Cyanosis.

3 Labored Breathing or Persistent Cyanosis?

◦ If Yes:

▪ Position and clear the airway, monitor SpO₂, and provide supplementary O₂ as needed. Consider CPAP (Continuous Positive Airway Pressure).

▪ Follow up with post-resuscitation care and team debriefing.

◦ If No: Continue with routine care as described earlier.

Further Resuscitation (If HR Remains Low)

4 HR Below 100/min After PPV?

◦ If Yes:

▪ Check chest movement and take corrective ventilation steps if needed (e.g., using an endotracheal tube (ETT) or laryngeal mask).

◦ If No: Monitor and continue care.

5 HR Below 60/min?

◦ If Yes:

▪ Intubate if not already done.

▪ Start chest compressions coordinated with PPV using 100% O₂.

▪ Use an ECG monitor and consider an umbilical venous catheter (UVC) for access.

◦ If No: Continue monitoring.

6 HR Still Below 60/min After Compressions?

◦ If Yes:

▪ Administer IV Epinephrine.

▪ If HR remains persistently below 60/min, consider hypovolemia (low blood volume) or pneumothorax (collapsed lung) as potential causes.

Additional Information

• Targeted Preductal SpO₂ After Birth: The chart lists target oxygen saturation (SpO₂) levels for a newborn at different time intervals post-birth:

◦ 1 min: 60%–65%

◦ 2 min: 65%–70%

◦ 3 min: 70%–75%

◦ 4 min: 75%–80%

◦ 5 min: 80%–85%

◦ 10 min: 85%–95%

Context

This algorithm is used in clinical settings, particularly in delivery rooms or neonatal intensive care units (NICUs), to guide healthcare providers in managing newborns who aren’t breathing adequately or have a low heart rate at birth. It emphasizes rapid assessment and intervention to ensure the infant stabilizes within the critical first minutes of life.