NRP 8th Edition Busy People Update #1 – December 2020

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NRP 8th Edition Busy People Update #1 – December 2020In June 2021, the American Academy of Pediatrics (AAP) and American Heart Association (AHA) will release the8th Edition of the Neonatal Resuscitation Program (NRP). The NRP 8th edition materials may be used beginning in June 2021; however, NRP 7th edition materials may beused until December 31, 2021. NRP 8th edition materials must be implemented by January 1, 2022. It is not necessary for NRP instructors to conduct NRP 8th edition Provider courses for all NRP providers byJanuary 1, 2022. NRP instructors and providers may retain their current renewal date. Instructors should briefNRP providers about 8th edition changes in practice and when those changes will go live. See the Fall/WinterNRP Instructor Update for strategies to transition to NRP 8th edition recommendations for practice. NRP 8th edition Instructor course materials will be available in June 2021. Instructor candidates may continueto use the NRP 7th edition instructor course materials through 2021; however, all 7th edition instructor courserequirements must be completed by December 31, 2021 or the instructor candidate must begin again with 8thedition instructor materials.Some program components are still in development. More information will be available in early 2021.SAVE THE DATEWatch for announcements about the Innov8te NRP: Introduction to the Neonatal Resuscitation Program,8th Edition webinar on February 18, 2021 that will answer all your questions about NRP 8th Edition and RQIfor NRP.NRP 8th EDITION MATERIALS – WHAT’S NEWThe Textbook of Neonatal Resuscitation, 8th edition, will be available on June 1, 2021. Textbook preorders begin January 1, 2021 with an arrival date around June 1, 2021. Translations of the textbook will follow shortly after the release of the English version. To guarantee that you receive a genuine AAP-produced resource, purchase textbooks from the AAP at The textbook and eBook price is 74.95.The Textbook of Neonatal Resuscitation, 8th Edition has 11 lessons and 3 Supplemental Lessons1. Foundations of Neonatal Resuscitation2. Anticipating and Preparing for Resuscitation3. Initial Steps of Newborn Care4. Positive-Pressure Ventilation (includes Laryngeal Mask)5. Endotracheal Intubation6. Chest CompressionsRev. 12/20

7. Medications8. Resuscitation and Stabilization of Babies Born Preterm9. Post-resuscitation Care10. Special Considerations11. Ethics and Care at the End of LifeSupplemental Lessons (for enhanced learning; no exam questions for this material)12. Improving Resuscitation Team Performance13. Resuscitation Outside the Delivery Room14. Bringing Quality Improvement to Your Resuscitation TeamThe NRP 8th edition Algorithm The NRP 8th edition algorithm is very similar to the NRP 7th edition algorithm (see Figure 1). It differs from the algorithm published in the in the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 5: Neonatal Resuscitation in style and wordchoice for educational efficiency, but it does not conflict with the published science in the 2020 guidelines.NRP 8th edition Practice ChangesSee Table 1 for an overview of significant changes in recommended practice.The Curriculum: NRP Essentials and NRP Advanced The NRP Steering Committee made the decision to offer two course options so that NRP providers could excelin the course material most relevant to their role and personnel resources. Each organization will decide who should be NRP Essentials providers and who should be NRP Advanced providers. This policy should be written before your NRP 8th edition Provider Courses begin. If a licensed healthcare professional is unsure about which NRP level to take, they should probably choose NRPAdvanced. The AAP will not deter any NRP learner from taking either course option.NRP Essentials: For anyone involved in the care of a newborn The NRP Essentials participant will be responsible for the material in Lessons 1 through 4 only. The NRP Essentials learner may study additional lessons for knowledge enhancement (Lessons 5 through 11 andSupplemental Lessons) but will not be tested on that material. NRP Essentials is most appropriate for those assigned responsibility for the newborn at birth when there are noapparent perinatal/neonatal risk factors and for those who care for healthy newborns after birth. NRP Essentialsmay not be appropriate for health care professionals who will participate in resuscitation beyond positive-pressure ventilation (PPV).NRP Advanced: For anyone expected to participate in resuscitation beyond PPV The NRP Advanced learner will be responsible for the material in Lessons 1 through 11. The NRP Advanced

learner may study Supplemental Lessons but will not be tested on those lessons. NRP Advanced is suited for health care professionals who serve as members of the resuscitation team in thedelivery room or in other settings where complex neonatal resuscitation is required. NRP Advanced may also be appropriate for health care professionals in smaller hospital facilities with fewer personnel where most health care professionals who attend births or care for newborns are expected to participatein newborn resuscitation.Provider Course FormatThe NRP Provider course requirements include an online exam, skills evaluation, and simulation and debriefing. TheNRP 8th edition does not include eSim cases.The NRP 8th edition suggests the use of two course formats, suitable for Essentials and Advanced learners.Provider Course Format #1: Sequential Practice and Evaluation This format is most appropriate for new NRP learners and those who infrequently use NRP Essentials or Advanced skills. In this format, learners will sequentially review and practice the skills from each lesson within the Essentials orAdvanced curriculum with the instructor. At the end of each lesson, the instructor uses the NRP Practice Scenarios in the textbook to evaluate the learner’sability to lead their team through the resuscitation in the correct sequence and perform the relevant technicalskills. Each Practice Scenario builds on the knowledge and skills from previous lessons, giving the instructor anopportunity to observe each learner lead their team through a series of scenarios of increasing complexity. When the learner has completed all Practice Scenarios in their course without requiring significant corrections/coaching, they have successfully passed the final component of evaluation in the NRP Provider Course and mayproceed to Simulation and Debriefing.Provider Course Format #2: Comprehensive Skills Test (“test out”) Provider Course participants who resuscitate newborns frequently and are experts at resuscitation (Essentials orAdvanced skills) may “test out” of the sequential practice and evaluation course by leading their team of participants (who are probably also testing out) through at least one NRP algorithm sequence and performing role-relevant skills. The Comprehensive Skills Test requires a team resuscitation and is not a one-person “check-off.” Testing out of complex resuscitation skills is not appropriate for health care professionals who rarely participatein complex resuscitation. In hospitals where complex resuscitation is an uncommon occurrence, it is possiblethat no one will be eligible to test out of the skills in Lessons 5 through 7. Learners who successfully “test out” have passed the final evaluation point of the NRP Provider Course and mayproceed to Simulation and Debriefing. Learners who make significant errors and require coaching during the scenario(s) should be directed to theirhospital NRP remediation plan or to the Provider Course that uses the sequential practice and evaluation format. This format is not designed to be a “short course.” For expert resuscitators who test out, the simulation anddebriefing component is an opportunity to practice challenging scenarios that require critical thinking andeffective teamwork and communication. What scenarios do they find most stressful? What NRP Key BehavioralSkills are lacking in clinical practice? Simulation and Debriefing is the safe place to take on these challenges.

NRP Provider Renewal Learners will self-study the Textbook and complete the lessons within their designated course (NRP Essentials or NRPAdvanced). Provider course completion cards are valid for two years, until the end of the course month. For example, anyone whopasses a course in April would have a valid card through the last day of April, 2 years later.Information for Instructors Current NRP instructors do not need to take the NRP 8th edition instructor course. Review the new NRP Instructorcourse materials so that you know what is expected of an instructor who teaches NRP 8th edition Provider courses.Read the 8th edition textbook and complete any instructor education materials offered to help instructors transitionlearners from NRP 7th edition to NRP 8th edition. An NRP instructor in good standing remains an NRP instructor as long as the requirements to maintain instructorstatus are met by their renewal date, which is every 2 years. The NRP instructor must teach or co-teach at least 2 courses during the 2-year renewal period, pass the NRP Instructor Exam, and complete the instructor renewal bundle. If an instructor’s status expires prior to meeting maintenance requirements, they must meet the current edition’s instructor eligibility requirements and complete the NRP Instructor course requirements.Information for Instructor Candidates Eligibility criteria for becoming an instructor has not changed from the NRP 7th edition and is as follows: Instructor candidates must have a current NRP 7th edition provider card or NRP 8th edition Advanced provider card. An NRP instructor candidate must be a physician, registered nurse/nurse practitioner, respiratory care practitioner, orphysician assistant with experience in the hospital care of newborns in the delivery room. The NRP instructor candidate must 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.What is RQI? The American Academy of Pediatrics is collaborating with RQI Partners, LLC to improve the efficiency of education and training in US hospitals. RQI for NRP is a self-directed, simulation-based, mastery learning and quality improvement resuscitation program for health care professionals. The program design islow-dose, high-frequency quarterly learning and skill sessions. Learn the details about RQI for NRP at the February 18th webinar (see Save the Dateabove).What Stays the Same for NRP 8th Edition? The AAP requires NRP Provider Card renewal every 2 years, but your facility may require more frequent renewal. It isthe institution’s responsibility to determine the consequence of allowing NRP Provider status to expire. Any person who works with newborns is eligible to take an NRP Provider course; however, the course has little relevance for a person who has never seen the birth of a heathy term newborn. NRP does not certify or ensure competence to perform resuscitation skills in an actual resuscitation. The recommended NRP instructor to learner ratio at a Provider course is 1 instructor to 3-4 learners.

More information about NRP 8th edition, including the Learning Management System (LMS), RQI for NRP, and otheradministrative information will be available in early 2021.Table 1: Overview of NRP 8th Edition Practice ChangesChangeNRP 7th EditionNRP 8th EditionUmbilical cord management plan added to 4 prebirth questions, replacing “How many babies?”The 4 pre-birth questions: (1) Gestational age? (2)Amniotic fluid clear? (3) How many babies? (4)Additional risk factors?The 4 pre-birth questions: (1) Gestational age? (2)Amniotic fluid clear? (3) Additional risk factors?(4) Umbilical cord management plan?Initial steps reordered to better reflect commonpractice.Initial steps: Warm and maintain normal temperature, position airway, clear secretions if needed,dry, stimulate.Initial steps: Warm, dry, stimulate, position airway,suction if needed.An electronic cardiac monitor is recommendedearlier in the algorithmAn electronic cardiac monitor is the preferredmethod for assessing heart rate during cardiaccompressions.When an alternative airway becomes necessary,a cardiac monitor is recommended for the mostaccurate assessment of the baby’s heart rate.Epinephrine intravenous/intraosseous (IV/IO) flushvolume increased.Flush IV/IO epinephrine with 0.5 to 1 mL normalsalineFlush IV/IO epinephrine with 3 mL normal saline(applies to all weights and gestational ages)Epinephrine IV/IO and endotracheal doses havebeen simplified for educational efficiency. Thedosage range is unchanged. The simplified doses(IV/IO and ET) do not represent an endorsementof any particular dose within the recommendeddosing range. Additional research is needed.Range for IV or IO dose 0.01 - 0.03 mg/kg(equal to 0.1 - 0.3 mL/kg)The suggested initial IV or IO dose 0.02 mg/kg(equal to 0.2 mL/kg)Expanded timeframe for cessation of resuscitativeeffortsIf there is a confirmed absence of heart rate after10 minutes of resuscitation, it is reasonable tostop resuscitative efforts; however, the decision tocontinue or discontinue should be individualized.Range for endotracheal dose 0.05 - 0.1 mg/kg(equal to 0.5 – 1 mL/kg)IV intravenous IO intraosseous ET endotracheal HR heart rateThe suggested endotracheal dose (while establishing vascular access) 0.1 mg/kg(equal to 1 mL/kg)If confirmed absence of HR after all appropriatesteps performed, consider cessation of resuscitation efforts around 20 minutes after birth(decision individualized on patient and contextualfactors).

Figure 1Neonatal Resuscitation Program 8th Edition AlgorithmAntenatal counseling.Team briefing.Equipment check.BirthTerm gestation?Good tone?Breathing or crying?YesStay with mother for initial steps,routine care, ongoing evaluation.NoLabored breathing orpersistent cyanosis?1 minuteNoWarm, dry, stimulate, positionairway, suction if needed.Apnea or gasping?HR 100 bpm?YesYesPosition airway, suction if needed.Pulse oximeter.Oxygen if needed.Consider CPAP.PPV.Pulse oximeter.Consider cardiac monitor.HR 100 bpm?NoYesEnsure adequate ventilation.Consider ETT or laryngeal mask.Cardiac monitor.NoHR 60 bpm?YesETT or laryngeal mask.Chest compressions.Coordinate with PPV-100% oxygen.UVC.NoHR 60 bpm?YesPost-resuscitation care.Team debriefing.Target Oxygen Saturation Table1 min60%-65%2 min65%-70%3 min70%-75%4 min75%-80%5 min80%-85%10 min85%-95%Initial oxygen concentration for PPVIV epinephrine every 3-5 minutes.If HR remains 60 bpm, Consider hypovolemia. Consider pneumothorax. 35 weeks’ GA2 1% ox yge n 35 weeks’ GA2 1% -3 0 % ox yge n

Watch for announcements about the Innov8te NRP: Introduction to the Neonatal Resuscitation Program, 8th Edition webinar on February 18, 2021 that will answer all your questions about NRP 8th Edition and RQI for NRP. NRP 8th EDITION MATERIALS – WHAT’S NEW The Textbook of Neonatal Resuscitation, 8th edition, will be available on June 1, 2021.