👶 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.
Neonatal Resuscitation Decision (NRP)
Current phase
Current heart rate (bpm)
Breathing (needed only at initial evaluation)
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.