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Review NRP: part I Lone Star: Kingwood college. By Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP. List the equipment that you need to assemble in the delivery room to take care of a newborn. question. You need to assemble: Clean dry warmed towels or blankets

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Review NRP: part I Lone Star: Kingwood college

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review nrp part i lone star kingwood college

Review NRP: part ILone Star: Kingwood college

By Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP


You need to assemble:

    • Clean dry warmed towels or blankets
    • Self-inflating bag and mask in various neonatal sizes
    • 02 Flow meter
    • Laryngoscope , blades & ET tubes to fit newborns
    • Suction catheters, and meconium aspirator

You ask if:

  • The baby is term
  • The amniotic fluid is clear
  • The baby is breathing or crying
  • The baby has good muscle tone

If your baby is term gestation, is breathing well and has clear amniotic fluid and good muscle tone, what do you do with him?


If the baby seems ok, we need to first dry him off by wiping him down with dry warmed towels.

  • Replace the towels as he get them wet
  • Position him so his airway is patent and clear as necessary
  • Assess his color
  • If there is no change in his appearance give him to mother

The premature infant is at risk for respiratory distress

  • Check his respirations and pulse
  • He is at increased risk for cold stress so warm and dry him and watch his response to stimulation
  • is his muscle tone good?

Establish airway by placing baby in sniffing position with shoulder roll under her

  • You would start her on supplementary 02 by blow by with cupped hands for reservoir
  • Make sure she is warm and dry, and gently stimulate her for 30 seconds
  • Reassess breathing? Is it shallow, gasping. Is the baby pinking up?
  • If not, start mask bagging with 02

How do we deal with the cyanotic infant.

  • Lips are blue; fingers are blue; toes are blue

Establish the airway with sniffing position

  • Administer blow by 02 and observe for 30 seconds
  • Gentle stimulation if breathing is irregular
  • Continue to monitor RR and HR
  • Once the baby pinks up on supplementary 02 he can be sent for observational care under 02
  • If he still has central cyanosis, continue 02 until he pinks up
  • Get ABG and pulse oximeter on him

Measure the pulse at the base of the umbilical cord as it goes into the baby.

  • Tap finger on the bed so others can count the HR
  • Count for 6 seconds and multiply by 10 for HR

If the baby is meconium-stained and is vigorous-- we would clear mouth and then nose with bulb syringe

  • Observe the baby for color and for HR and RR
  • If the baby is floppy, HR less than 100 BPM or depressed respirations, with observation by laryngoscope, suction oral and pharyngeal intubate without mask bagging, suction below the cords and remove the ET tube.
  • Reassess baby. Repeat till airway clear
  • Or baby needs more resuscitation

No, there is not enough flow going through this type of bag

    • Use non-self inflating bag and mask
    • Or 02 with hands cupped over face for reservoir
    • Or hand-held simple 02 mask

If the baby goes apnic

  • or the respirations are irregular
  • and there is central cyanosis that failed to respond to supplementary 02
  • If the HR drops below 100 BPM

The self-inflating bag with 02

  • The flow inflating bag
  • The T-piece resuscitator


  • The self inflating bag can be used without supplementary 02
  • Pressure release can protect the baby from excessive PIP
  • Will inflate even if there is a poor seal
  • Requires a reservoir
  • for high Fi02
  • Cannot deliver free flow 02
  • Cannot deliver CPAP

ADVANTAGES of flow inflated bags

  • Can deliver free-flow 02
  • Can deliver CPAP
  • Can have fine control over Fi02 based on blender settings
  • Easy to see if the face seal is good
  • Must have tight seal
  • Must have gas source
  • Usually doesn’t have safety pop off

You observe the HR

  • You look at chest rise
  • You look at patient’s skin color and muscle tone
  • You hear bilateral breath sounds [on axillary line on both sides]