Neonatal Resuscitation Decision (NRP) — free guideline decision tool
The Neonatal Resuscitation Program (NRP) algorithm decides the next step at birth from heart rate and the resuscitation phase, escalating from positive-pressure ventilation to chest compressions to epinephrine.
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Implements the decision logic from published clinical guidelines.
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Nothing is uploaded. Results are for licensed clinicians only.
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 | 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
| Current phase | After 60 s of compressions + ventilation |
|---|---|
| Current heart rate | 80 bpm |
| Breathing (needed only at initial evaluation) | Apnea / gasping |
→Next stepHR ≥ 60
- Current：Phase: After 60 s compressions + ventilation; HR 80 bpm
- Next step：HR ≥ 60: stop chest compressions, continue PPV (40–60/min) until HR > 100 and spontaneous breathing is established
- 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
Common questions
What is Neonatal Resuscitation Decision (NRP)?
The Neonatal Resuscitation Program (NRP) algorithm decides the next step at birth from heart rate and the resuscitation phase, escalating from positive-pressure ventilation to chest compressions to epinephrine.
How is Neonatal Resuscitation Decision (NRP) calculated? What is the core formula?
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 (IV/IO 0.01–0.03 mg/kg) q3–5 min.
When is Neonatal Resuscitation Decision (NRP) used?
Use at delivery when a newborn is depressed, to identify the correct next intervention based on heart rate and what has already been done.
What are the key clinical points for Neonatal Resuscitation Decision (NRP)?
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 (10 mL/kg) are reserved for HR < 60 despite 60 s of coordinated compressions and ventilation; search concurrently for reversible causes (hypovolemia, pneumothorax).
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.
How is Neonatal Resuscitation Decision (NRP) calculated in practice? Can you show a worked example?
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） Inputs: Current phase After 60 s of compressions + ventilation, Current heart rate 80 bpm, Breathing (needed only at initial evaluation) Apnea / gasping → Result: Next step HR ≥ 60（Current: Phase: After 60 s compressions + ventilation; HR 80 bpm, Next step: HR ≥ 60: stop chest compressions, continue PPV (40–60/min) until HR > 100 and spontaneous breathing is established, 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）
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The Neonatal Resuscitation Program (NRP) algorithm decides the next step at birth from heart rate and the resuscitation phase, escalating from positive-pressure ventilation to chest compressions to epinephrine.
Open guideline tool →For licensed clinicians. Not a substitute for clinical judgement.
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