👶 Neonatal Resuscitation Decision (NRP)
UseUse at delivery when a newborn is depressed, to identify the correct next intervention based on heart rate an…
Source2025 AHA/AAP Neonatal Resuscitation Guidelines (Circulation 2025, PMID 41122887)
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Effective ventilation is the single most important step; most newborns respond to PPV alone, and a rising heart rate is the best indicator that ventilation is working.
When to use
Use at delivery when a newborn is depressed, to identify the correct next intervention based on heart rate and what has already been done.
How it works
Heart-rate driven: HR < 100 or apnea/gasping → PPV; HR < 60 after 30 s of effective PPV → chest compressions (3:1, 120 events/min) + 100% O₂ + advanced airway; HR still < 60 after 60 s of compressions + ventilation → epinephrine (umbilical vein or IO), every 3–5 min. The AHA 2025 algorithm lists preductal SpO₂ targets: 2 min 65–70%, 3 min 70–75%, 4 min 75–80%, 5 min 80–85%, 10 min 85–95%.
Key points
- Effective ventilation is the single most important step; most newborns respond to PPV alone, and a rising heart rate is the best indicator that ventilation is working.
- Chest compressions begin only after 30 s of demonstrably effective PPV has failed to raise HR ≥ 60, using a 3:1 compression-to-ventilation ratio with 100% oxygen.
- Epinephrine and volume are reserved for HR < 60 despite 60 s of coordinated compressions and ventilation; search concurrently for reversible causes (hypovolemia, pneumothorax).
References
- [Guideline / primary source]2025 AHA/AAP Neonatal Resuscitation Guidelines (Circulation 2025, PMID 41122887)
- [Guideline / primary source]AAP/AHA Neonatal Resuscitation Program (NRP), 8th edition.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Current phase | After 30 s of effective PPV |
|---|---|
| Current heart rate | 80 bpm |
| Breathing (needed only at initial evaluation) | Regular, vigorous breathing |
→Next stepHR 60–99
- Current：Phase: After 30 s effective PPV; HR 80 bpm
- Next step：HR 60–99: continue and optimize PPV (ensure effective ventilation, MR SOPA correction), consider laryngeal mask / endotracheal intubation to improve ventilation
- Key thresholds：HR < 100 or apnea/gasping → PPV; HR < 60 after 30 s effective PPV → chest compressions (3:1) + 100% O₂; HR still < 60 after 60 s of compressions + ventilation → epinephrine. Rising heart rate is the best indicator of effective ventilation
| Current phase | Initial evaluation (after birth / initial steps) |
|---|---|
| Current heart rate | 80 bpm |
| Breathing (needed only at initial evaluation) | Regular, vigorous breathing |
→Next stepBegin positive-pressur
- Current：Phase: Initial evaluation; HR 80 bpm; breathing regular
- Next step：Begin positive-pressure ventilation immediately (PPV, 40–60/min; term: 21% air, preterm: blended O₂), attach SpO₂ to the right wrist — effective ventilation is the single most important step in neonatal resuscitation; if ventilation is inadequate, run the MR SOPA corrective steps
- Key thresholds：HR < 100 or apnea/gasping → PPV; HR < 60 after 30 s effective PPV → chest compressions (3:1) + 100% O₂; HR still < 60 after 60 s of compressions + ventilation → epinephrine. Rising heart rate is the best indicator of effective ventilation
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Neonatal Resuscitation Decision (NRP)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Neonatal Resuscitation Decision (NRP) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Neonatal Resuscitation Decision (NRP) calculated in practice? Can you show a worked example?
- Inputs: Current phase After 30 s of effective PPV, Current heart rate 80 bpm, Breathing (needed only at initial evaluation) Regular, vigorous breathing → Result: Next step HR 60–99（Current: Phase: After 30 s effective PPV; HR 80 bpm, Next step: HR 60–99: continue and optimize PPV (ensure effective ventilation, MR SOPA correction), consider laryngeal mask / endotracheal intubation to improve ventilation, Key thresholds: HR < 100 or apnea/gasping → PPV; HR < 60 after 30 s effective PPV → chest compressions (3:1) + 100% O₂; HR still < 60 after 60 s of compressions + ventilation → epinephrine. Rising heart rate is the best indicator of effective ventilation） Inputs: Current phase Initial evaluation (after birth / initial steps), Current heart rate 80 bpm, Breathing (needed only at initial evaluation) Regular, vigorous breathing → Result: Next step Begin positive-pressur（Current: Phase: Initial evaluation; HR 80 bpm; breathing regular, Next step: Begin positive-pressure ventilation immediately (PPV, 40–60/min; term: 21% air, preterm: blended O₂), attach SpO₂ to the right wrist — effective ventilation is the single most important step in neonatal resuscitation; if ventilation is inadequate, run the MR SOPA corrective steps, Key thresholds: HR < 100 or apnea/gasping → PPV; HR < 60 after 30 s effective PPV → chest compressions (3:1) + 100% O₂; HR still < 60 after 60 s of compressions + ventilation → epinephrine. Rising heart rate is the best indicator of effective ventilation）