NRP 9th Edition SVH L&D SL

NRP 9th Edition

updates & changes

CORD MANAGEMENT

NRP 8th

NRP 9th

• Deferred cord clamping is at minimum 60 seconds
• Non-vigours baby 35-42 weeks, cord "milking" acceptable (milk the cord 3-4x towards the baby)
• Non-vigours baby 28-34 weeks not enough evidence to "milk" cord
• Under 28wks DO NOT MILK CORD

• Deferred cord clamping 30-60 seconds

INITAL STEPS

NRP 9th (within 1 minute of life)

NRP 8th

• Term? Good Tone? Breathing or Crying? YES ---> Initiate Skin to Skin, continue ongoing evaluation

• Term? Good Tone? Breathing or Crying? NO---> Warm, Dry, Position, Stimulate & Clear airway if needed
• Apnea or gasping? HR under 100bpm?
• YES --->
• 1. Ventilate (PPV)
• 2. Pulse Ox.

• 3. Consider Cardiac Monitor
• NO --->
• Labored breathing or persisent cyanosis?
• YES --->
• 1. Pulse Ox.
• 2. Oxygen if needed
• 3. Consider CPAP

• Warm
• Dry
• Stimulate
• Position Airway
• Suction if needed

TARGET OXYGEN SATURATION

NRP 9th

NRP 8th

Starts at 2 minutes of life (this change is due to the fact that the pulse ox can take 1-2 minutes to get an accurate reading)

Starts at 1 minute of life

OXYGEN CONCENTRATION

NRP 9th

NRP 8th

VENTILATION RATE

NRP 8th

NRP 9th

30-60 BREATHS PER MINUTE

40-60 BREATHS PER MINUTE

INITIAL PIP

NRP 8th

NRP 9th

Start with a PIP of 20-25 cm H2O

Start at PIP of 25 for infants greater than or equal to 32wks gestation

VENTILATION CORRECTIVE STEPS

NRP 9th

NRP 8th

Use MRSOPA in whichever step is best for the infant

Use MRSOPA in order

LARYNGEAL MASK AIRWAY

NRP 9th

NRP 8th

LMA is used as an alternative

LMA or Face Mask are PRIMARY devices for ventilation

ENDOTRACHEAL TUBE SIZING

NRP 9th

NRP 8th

Weight cut off for 2.5 mm tube is 1200g and 3.0 mm tube is 2200g

ENDOTRACHEAL TUBE DEPTH

NRP 9th

NRP 8th

Resources for NRP

NRP wesbite