👶 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.
Clinical takeaway
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.
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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 (IV/IO 0.01–0.03 mg/kg) q3–5 min.
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 (10 mL/kg) are reserved for HR < 60 despite 60 s of coordinated compressions and ventilation; search concurrently for reversible causes (hypovolemia, pneumothorax).
References
- Aziz K, et al. Part 5: Neonatal Resuscitation: 2020 AHA Guidelines for CPR and ECC. Circulation 2020.
- AAP/AHA Neonatal Resuscitation Program (NRP), 8th edition.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.
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
Frequently asked 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）