Neonatal resuscitation program algorithm with timeline- A concise flow chart for delivery room resuscitation

To the Editor,

Resuscitation Plus,

The neonatal resuscitation program (NRP) is an evidence-based approach to the care of the newborn at birth.¹ It facilitates effective team-based care for healthcare professionals who care for newborns at the time of delivery. Most newborns do not require resuscitation at birth; however, the need for assistance is unpredictable. The NRP Algorithm describes the steps you will follow to evaluate and resuscitate a newborn. However, the presence of a timeline in a neonatal resuscitation algorithm is of utmost importance. We have prepared a concise algorithm entirely derived from the 8th edition of the neonatal resuscitation program for use in delivery room resuscitation.

This scheme provides step by step guide for clinicians: it has a timeframe as recommended by NRP. Neonatal resuscitation is a complex process. It is essential to act judiciously and efficiently ensuring one has performed sequential steps of each block before administering the next step without delay. It has been observed that several teams working in a confined space at the same time in a stressful period of resuscitation may lead to inefficiency and confusion. This algorithm highlights the timeline as well as appropriate action for each assessment.

The algorithm starts with the golden minute, which is the first minute after birth, and its goal is to initiate positive pressure ventilation (PPV) at 1 minute. Components of the golden minute are a. Assessment of need for resuscitation, b. Initial steps (30 s), c. Assessment of heart rate/breathing, d. Begin PPV within 60 s of birth if the neonate is gasping/apneic or heart rate(HR) <100/min. With PPV, assess chest movements after 15 s. If there is visible chest movement, continue PPV for 15 s (a total of 30 s). If no chest movement is observed, proceed through corrective steps until you get visible adequate chest movement; then administer PPV for 30 s. If no chest movement with corrective steps, it indicates the need for an alternative airway. Check heart rate after 30 s of PPV with an alternative airway, if HR < 60/min then chest compressions are to be initiated and oxygen should be increased to 100%. Check heart rate after 60 s of compressions. Epinephrine is to be given after 60 s of chest compression if HR < 60/min. This algorithm has been shown in Fig. 1 in detail. Often simple adjustments in a working environment may significantly improve the outcome. This algorithm aims to evolve a strategy in the delivery room for better neonatal resuscitation. Using this algorithm in the delivery room may improve ergonomics, and human factors, and help individuals perform tasks more effectively and reduce errors. We believe this algorithm will be useful for neonatologists/pediatricians for quick review. Displaying this algorithm in the resuscitation room as a wall chart/portrait will be useful and will guide clinicians through the process of resuscitation. This resuscitation guide is useful for resuscitation in the delivery room only and does not apply to other scenarios. This guide is a quick review, and the authors strongly recommend that providers read the ‘Textbook of neonatal resuscitation’ for a strong foundation.

Fig. 1.

The algorithm provides a step-by-step guide for clinicians and is a systematic plan of action for resuscitation. Throughout the algorithm, hexagons indicate assessments and rectangles show actions that may be required.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.