Textbook Of Neonatal Resuscitation Neonatal

2y ago
59 Views
7 Downloads
7.99 MB
345 Pages
Last View : 2m ago
Last Download : 2m ago
Upload by : Asher Boatman
Transcription

6th EditionThe extensively revised and updated 6th edition of the Neonatal ResuscitationProgram (NRP) textbook and accompanying DVD-ROM are designed in accord withthe program’s curriculum changes and sharpened focus on active, hands-on learning.The text facilitates the newly recommended self-paced learning approach. Self-studyis optimized to help students prepare for the mandatory online examination thatreplaces the traditional written test. It also complements the simulations and case-basedscenarios at the heart of the new NRP.Content updates throughout the text and DVD-ROM reflect the 2010 AmericanAcademy of Pediatrics (AAP)/American Heart Association Guidelines for NeonatalResuscitation. Must-know new material includes the latest recommendations acrosskey areas of change, including Revisions in the NRP flow diagram Elimination of evaluation of amniotic fluid in initial rapid assessment Use of supplemental oxygen during resuscitation Use of pulse oximetry Chest compression proceduresNeonatal Resuscitation TextbookTextbook of Neonatal Resuscitation The book includes a companion DVD-ROM (for use on both PC and Mac), bringinga higher level of interactivity to the learning process. Active learning features on theDVD include multi-decision point scenarios and randomly generated clinical problemsand outcomes.To order NRP materials, visit the AAP Online Bookstore at www.aap.org/bookstore.Minimum System RequirementsWindows XP, Windows 7, or VistaIntel Pentium III processor; Microsoft Windows XP with Service Pack 2, Windows 7 or Windows Vista; 256 MB ofRAM; High Color (16-bit) display; 800 600 display resolution; Sound Card; 8 DVD-ROM drive; 500 MB availablehard disk space.Macintosh OS XPowerPC G5 or Intel processor; Mac OS X v10.4; 512MB of RAM; 500 MB free hard disk space; 8 DVD-ROMdrive; 800 600 display with thousands of colors; speakers or headphones.NeonatalResuscitationTEXTBOOK6th EditionAAP/AHA

Textbook of NeonatalResuscitation, 6th EditionEDITORJohn Kattwinkel, MD, FAAPASSISTANT EDITORSKhalid Aziz, MD, FRCPCChristopher Colby, MD, FAAPMarilyn Escobedo, MD, FAAPKaren D. Fairchild, MD, FAAPJohn Gallagher, RRT-NPSEDUCATIONAL DESIGN EDITORJerry Short, PhDN R P TMASSOCIATE EDITORSJane E. McGowan, MD, FAAPJeanette Zaichkin, RN, MN, NNP-BCJay P. Goldsmith, MD, FAAPLouis P. Halamek, MD, FAAPPraveen Kumar, MD, FAAPGeorge A. Little, MD, FAAPBarbara Nightengale, RN, MSN,NNP-BCJeffrey M. Perlman, MB, ChB,FAAPMildred Ramirez, MD, FACOGSteven Ringer, MD, PhD, FAAPGary M. Weiner, MD, FAAPMyra H. Wyckoff, MD, FAAPMANAGING EDITORSRachel Poulin, MPHWendy Marie Simon, MA, CAEBased on original text byRonald S. Bloom, MD, FAAPCatherine Cropley, RN, MNTextbook of Neonatal Resuscitation, 6th Edition, Interactive Multimedia DVD-ROM:AAP NRP FM i-xiv.indd iEditorsLouis P. Halamek, MD, FAAPJeanette Zaichkin, RN, MN, NNP-BCAssociate EditorsJoDee Anderson, MD, MsEd, FAAPDana A. V. Braner, MD, FAAPSusanna Lai, MPHJohn Kattwinkel, MD, FAAPAssistant EditorsKhalid Aziz, MD, FRCPCChristopher Colby, MD, FAAPMarilyn Escobedo, MD, FAAPKaren D. Fairchild, MD, FAAPJohn Gallagher, RRT-NPSJay P. Goldsmith, MD, FAAPLouis P. Halamek, MD, FAAPPraveen Kumar, MD, FAAPDouglas T. Leonard, MD, FAAPGeorge A. Little, MD, FAAPBarbara Nightengale, RN, MSN,NNP-BCContributorsJulie Arafeh, RN, MSNKimberly D. Ernst, MD, MSMI,FAAPJay P. Goldsmith, MD, FAAPCheryl Major, RNC-NIC, BSNPtolemy RunkelScott RunkelBret Van HornJeffrey M. Perlman, MB, ChB,FAAPMildred Ramirez, MD, FACOGSteven Ringer, MD, PhD, FAAPGary M. Weiner, MD, FAAPMyra H. Wyckoff, MD, FAAPAnimatorScott Eman3/31/11 2:50 PM

Sixth edition, 2011Fifth edition, 2006Fourth edition, 2000Third edition, 1994Second edition, 1990First edition, 1987Library of Congress Catalog Card No. 2010907499ISBN-13: 978-1-58110-498-1NRP301All rights reserved. Printed in the United States of America. Except as permitted under the United States CopyrightAct of 1976, no part of the material protected by this copyright notice may be reproduced or utilized in any form,electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system,without written permission from the copyright owner.The material is made available as part of the professional education programs of the American Academy ofPediatrics and the American Heart Association. No endorsement of any product or service should be inferred or isintended. Every effort has been made to ensure that contributors to the Neonatal Resuscitation Program materialsare knowledgeable authorities in their fields. Readers are nevertheless advised that the statements and opinionsexpressed are provided as guidelines and should not be construed as official policy of the American Academy ofPediatrics or the American Heart Association. The recommendations in this publication and the accompanyingmaterials do not indicate an exclusive course of treatment. Variations, taking into account individual circumstances,nature of medical oversight, and local protocols, may be appropriate. The American Academy of Pediatrics and theAmerican Heart Association disclaim any liability or responsibility for the consequences of any actions taken inreliance on these statements or opinions.The American Academy of Pediatrics reserves the right to disclose personal information related to course completionof course participants/providers for administrative purposes such as to verify participation or classes taken or tovalidate the status of any Course Completion Card. In no event shall the American Academy of Pediatrics orAmerican Heart Association have any liability for disclosure or use of information for such purposes or responsibilityfor the consequences of any actions taken in reliance on such information.Copyright 2011 by American Academy of Pediatrics and American Heart Association5-246/04111 2 3 4 5 6 7 8 9 10AAP NRP FM i-xiv.indd ii3/31/11 2:51 PM

AcknowledgmentsNRP Steering Committee MembersLouis P. Halamek, MD, FAAP, Co-chair, 2007-2011Jane E. McGowan, MD, FAAP, Co-chair, 2009-2011Christopher Colby, MD, FAAPMarilyn Escobedo, MD, FAAPKaren D. Fairchild, MD, FAAPGeorge A. Little, MD, FAAPSteven Ringer, MD, PhD, FAAPGary M. Weiner, MD, FAAPMyra H. Wyckoff, MD, FAAPN R P TMLiaison RepresentativesMildred Ramirez, MD, FACOG,American College of Obstetricians and GynecologistsBarbara Nightengale, RN, MSN, NNP-BC,National Association of Neonatal NursesPraveen Kumar, MD, FAAP,AAP Committee on Fetus and NewbornKhalid Aziz, MD, FRCPC,Canadian Paediatric SocietyJohn Gallagher, RRT-NPS,American Association for Respiratory CareThe committee would like to express thanks to the following reviewers andcontributors to this textbook:American Academy of Pediatrics Committee on Fetus and NewbornInternational Liaison Committee on Resuscitation, Neonatal DelegationJeffrey M. Perlman, MB, ChB, FAAP, Co-chairSam Richmond, MD, Co-chairJonathan Wylie, MDFrancis Rushton, MD, FAAP, AAP Board-appointed ReviewerAmerican Heart Association Emergency Cardiovascular Care LeadershipLeon Chameides, MD, FAAPBrian Eigel, PhDMary Fran Hazinski, RN, MSNRobert Hickey, MD, FAAPVinay Nadkarni, MD, FAAPNEONATAL RESUSCITATIONAAP NRP FM i-xiv.indd iiiiii3/31/11 2:51 PM

AcknowledgmentsAssociated Education Materials for the Textbook of Neonatal Resuscitation, 6th EditionInstructor Manual for Neonatal Resuscitation, Jeanette Zaichkin, RN, MN, NNP-BC, EditorNRP Instructor DVD: An Interactive Tool for Facilitation of Simulation-based Learning, Louis P. Halamek,MD, FAAP, and Jeanette Zaichkin, RN, MN, NNP-BC, EditorsNRP Online Examination, Steven Ringer, MD, PhD, FAAP, and Jerry Short, PhD, EditorsNRP Reference Chart, Code Cart Cards, and Pocket Cards, Karen D. Fairchild, MD, FAAP, EditorNRP Simulation Poster, Louis P. Halamek, MD, FAAP, EditorSimply NRP , Gary Weiner, MD, FAAP, and Jeanette Zaichkin, RN, MN, NNP-BC, EditorsNeonatal Resuscitation Scenarios, Gary Weiner, MD, FAAP, and Jeanette Zaichkin, RN, MN, NNP-BC,EditorsHypix MediaScott RunkelPtolemy RunkelBret Van HornPhoto CreditsGigi O’Dea, RN, NICU at Sarasota Memorial HospitalAAP Life Support StaffWendy Marie Simon, MA, CAERory K. Hand, EdMRachel Poulin, MPHKristy CrillyNancy GardnerMelissa MarxBonnie MolnarNRP Education Workgroup ChairGary M. Weiner, MD, FAAPAmerican Heart Association Emergency Cardiovascular Care Pediatric SubcommitteePatricia HowardMarc D. Berg, MD, FAAP, Chair, 2009-2011Kelly Kadlec, MD, FAAPMonica E. Kleinman, MD, FAAP,Sharon E. Mace, MD, FAAPImmediate Past Chair, 2007-2009Bradley S. Marino, MD, FAAP, MPP, MSCEDianne L. Atkins, MD, FAAPReylon Meeks, RN, BSN, MS, MSN, EMT, PhDJeffrey M. Berman, MDVinay Nadkarni, MD, FAAPKathleen Brown, MD, FAAPJeffrey M. Perlman, MB, ChB, FAAPAdam Cheng, MDLester Proctor, MD, FAAPLaura Conley, BS, RRT, RCP, NPSFaiqa A. Qureshi, MD, FAAPAllan R. de Caen, MDKennith Hans Sartorelli, MD, FAAPAaron Donoghue, MD, FAAP, MSCEWendy Simon, MAMelinda L. Fiedor Hamilton, MD, MScMark A. Terry, MPA, NREMT-PEricka L. Fink, MD, FAAPAlexis Topjian, MD, FAAPEugene B. Freid, MD, FAAPElise W. van der Jagt, MD, FAAP, MPHCheryl K. Gooden, MD, FAAPArno Zaritsky, MD, FAAPJohn Gosford, BS, EMT-PivAAP NRP FM i-xiv.indd iv4/12/11 1:29 PM

ContentsN R P TMPrefaceNRP Provider Course OverviewL E S S O NL E S S O NL E S S O NL E S S O NL E S S O NL E S S O NL E S S O NL E S S O NL E S S O N1:2:3:4:5:6:7:8:9:Overview and Principles of Resuscitation . 1Initial Steps of Resuscitation . 37Use of Resuscitation Devices forPositive-Pressure Ventilation . 71Chest Compressions . 133Endotracheal Intubation andLaryngeal Mask Airway Insertion . 159Medications . 211Special Considerations . 237Resuscitation of Babies Born Preterm . 267Ethics and Care at the End of Life . 283Integrated Skills Station PerformanceChecklist (Basic) . 299Integrated Skills Station PerformanceChecklist (Advanced). 301NEONATAL RESUSCITATIONAAP NRP FM i-xiv.indd vv3/31/11 2:51 PM

ContentsAppendix:2010 American Heart Association Guidelines forCardiopulmonary Resuscitation and EmergencyCardiovascular Care . 303Index.321Evaluation FormviAAP NRP FM i-xiv.indd vi3/31/11 2:51 PM

PrefaceN R P TMBirth is a beautiful, miraculous,and very personal event for allinvolved. It’s an intimate andemotional time for a new motherand father when the baby theycreated together makes that initialcry and establishes first eye contactwith the new parents. But it’s alsoprobably the single mostdangerous event that most of uswill ever encounter in ourlifetimes. Our bodies are requiredto make more radical physiologicadjustments immediately followingbirth than they will ever have to doagain. It’s remarkable that morethan 90% of babies make thetransition from intrauterine toextrauterine life perfectlysmoothly, with little to noassistance required, and it’simportant that we not disrupt thatintimate and memorable momentfor the 90% of families where anuncomplicated birth takes placesmoothly. It’s for the remainingfew percent that the NeonatalResuscitation Program (NRP )was designed. While theproportion of newborns requiringassistance may be small, the realnumber of babies requiring help issubstantial because of the largenumber of births taking place. Theimplications of not receiving thathelp can be associated withproblems that last a lifetime oreven lead to death. The mostgratifying aspect of providingskillful assistance to acompromised newborn is thatyour efforts are most likely to besuccessful, in contrast to thediscouraging statistics associatedwith resuscitation attempts ofadults or older children. The timethat you devote to learning how toresuscitate newborns is time verywell spent.This textbook has a long history,with many pioneers from both theAmerican Academy of Pediatrics(AAP) and the American HeartAssociation (AHA) responsible forits evolution. National guidelinesfor resuscitation of adults wereinitially recommended in 1966 bythe National Academy of Sciences.In 1978, a Working Group onPediatric Resuscitation was formedby the AHA Emergency CardiacCare Committee. The groupquickly concluded thatresuscitation of newborns requireda different emphasis thanresuscitation of adults, with a focuson ventilation, rather thanrestitution of cardiac activity,being paramount. The formalspecialty of neonatology wasevolving at about that time and, by1985, the AAP and the AHAexpressed a joint commitment todevelop a training program aimedat teaching the principles ofneonatal resuscitation. Thepioneering leaders of this effortwere George Peckham and LeonChameides. A committee wasconvened to determine theappropriate format for theprogram, and the material writtenby Ron Bloom and Cathy Cropleywas selected to serve as the modelfor the new NRP textbook. Someof the text contained in this bookhas been unchanged from theoriginal textbook.Pediatric leaders, such as BillKeenan, Errol Alden, Ron Bloom,and John Raye, developed astrategy for disseminating theNRP. The strategy first involvedtraining a national facultyconsisting of at least onephysician-nurse team from eachstate. The national faculty taughtregional trainers who then trainedhospital-based instructors. By theend of 2010, more than 2.9 millionhealth care providers in the UnitedStates had been trained in thetechniques of neonatalresuscitation—quite anaccomplishment when oneNEONATAL RESUSCITATIONAAP NRP FM i-xiv.indd viivii3/31/11 2:51 PM

Prefaceconsiders that the original goal wasto strive to have at least one persontrained in neonatal resuscitation inattendance in each of theapproximately 5,000 deliveryrooms in the United States. TheNRP also has been used as a modelfor similar neonatal resuscitationprograms in 92 other countries.The science behind the programhas also undergone significantevolution. While the ABCD(Airway, Breathing, Circulation,Drugs) principles of resuscitationhave been standard for severaldecades, the details of how andwhen to accomplish each of thesteps and what to do differently fornewborns versus older children oradults have required constantevaluation and change. Also, whilethe recommendations traditionallyhave been based on opinions fromexperts in the field, recently therehas been a concerted effort to basethe recommendations onexperimental or experientialevidence, collected from studiesperformed in the laboratory,randomized control studiesconducted in hospitals, andobservational series systematicallycollected from clinicians.The AHA has addressed thisevaluation process by facilitatingperiodic internationalCardiopulmonary Resuscitationand Emergency Cardiac Care(CPR-ECC) conferences every 5 to8 years to establish guidelines forresuscitation of all age groups andfor all causes of cardiopulmonaryarrest. The AAP formally joinedthat process in 1992 fordevelopment of the guidelines forresuscitation of children andnewborns.The most recent CPR-ECC activitytook place over nearly 5 years andwas conducted in 2 parts. First,starting in late 2006, a series of 32questions identifying controversialissues regarding neonatalresuscitation were identified by theneonatology subgroup of theInternational Liaison Committeeon Resuscitation (ILCOR), led byJeff Perlman from the UnitedStates and Jonathan Wyllie fromthe United Kingdom. IndividualILCOR members were thenassigned to develop worksheets foreach question. Advances incomputerized databases and searchengines facilitated the literaturereview and permitted updating ofthe voluminous AHA detaileddatabase of publications regardingresuscitation. The informationfrom the worksheets was debatedin a series of conferences,following which an internationaldocument titled Consensus onCardiopulmonary Resuscitation(CPR) and EmergencyCardiovascular Care (ECC)Science With TreatmentRecommendations (CoSTR) waspublished simultaneously inCirculation (2010;122[suppl2]:S516-S538), Resuscitation(2010;81[suppl]:e260-287), andPediatrics (2010;126;e1319-e1344).Second, each resuscitation councilthat makes up ILCOR was chargedwith developing resuscitationguidelines appropriate for thehealth care resources existing in(each of) its own region(s) of theworld, but based on the scientificprinciples defined in CoSTR. Theneonatal portion of the U. S.Treatment Guidelines waspublished in Circulation(2010;122:S909-S919), andPediatrics (2010;126;e1400-e1413),and is reprinted in the back of thistextbook. As a result of thisprocess, each successive edition ofNRP contains morerecommendations that are basedon evidence, rather than simplyreflecting common practice. Weencourage you to review theevidence and, more importantly,to conduct the future studiesnecessary to further define theoptimum practices.The past edition of NRPintroduced 2 new chapters toaddress the unique challengespresented by stabilization andresuscitation of the baby bornpreterm (Lesson 8) and to discussthe important issues related to theethics of neonatal resuscitation(Lesson 9). Those chapters havebeen retained and updated in the6th edition. You will note a newalgorithm (“flow diagram”) in thisedition, with the evaluation andaction blocks changed to betterreflect scientific format. There area few important changes that willbe recognized by the seasonedNRP student. First, the initialquestions posed at the top of theflow diagram have been reducedfrom 4 to 3, with “clear amnioticfluid?” removed. While theguidelines for suctioningmeconium from the airway havenot changed, a careful review ofthe evidence failed to demonstratea need to intervene with a babyviiiAAP NRP FM i-xiv.indd viii3/31/11 2:51 PM

born at term who is meconiumstained but is breathing easily andexhibiting good muscle tone. Thissituation will occur in more than10% of births and the Committeefelt that such babies should not betaken from their mothers, asfurther assessment can be donewith minimal disruption of herfirst moments with her newdaughter or son.Second, far more evidence hasbeen published to strengthen ourunderstanding that increasing theblood oxygen levels above thoseexhibited by healthy babies born atterm provides no advantage, andthat administering excessiveoxygen can be injurious to tissuesthat have been previouslycompromised. Therefore, the newedition introduces new strategiesfor avoiding hyperoxemia. Also,several studies have demonstratedthat cyanosis can be normal for thefirst few minutes following birthand that skin color can be a verypoor indicator of oxygensaturation. Therefore, color hasbeen removed from the list ofprimary clinical signs unlesscyanosis is felt to be persistent, andcolor has been replaced byoximetry as the more reliablemeans of judging oxygen need. Itwas the consensus of theCommittee that if resuscitation isanticipated or required, the goalshould be to try to match theincrease in blood oxygenationexhibited by the uncompromisedhealthy baby born at term. Theseobservations and thisrecommendation will result insome changes in the equipmentrequired and the actions indicatedin the early stages of the flowdiagram. Oximeters, a compressedair source, and oxygen/air blenderswill need to be readily available inthe birthing area and are nowrecommended for use wheneversustained supplemental oxygen isthought to be necessary orwhenever the stage in the flowdiagram is reached at whichpositive pressure, either aspositive-pressure ventilation (PPV)or continuous positive airwaypressure (CPAP), is instituted. Atable has been added to designatethe Spo2 target goals, which havebeen defined by studying healthyterm babies. Accommodating thischange will present challenges tosome small hospitals and

Neonatal The extensively revised and updated 6th edition of the Neonatal Resuscitation Resuscitation Program (NRP) textbook and accompanying DVD-ROM are designed in accord with the program’s curriculum changes and sharpened focus on active, hands-on learning. The text facilitates the

Related Documents:

Neonatal Resuscitation Science, Education, and Practice The Role of the Neonatal Resuscitation Program Jane E. McGowan, MD ABSTRACT For almost 25 years, the Neonatal Resuscitation Program of the American Academy of Pediatrics has provided educa-tional tools that are used in the United States and thr

matters in neonatal resuscitation. Instead of Apgar score, healthcare professionals will focus on three factors at the time of birth: airway, breathing, and circulation. While adult resuscitation guidelines have moved to CAB, neonatal resuscitation still follows the ABCs because most neonatesFile Size: 1MBPage Count: 18

The Neonatal Resuscitation Program (NRP) of the American Academy of Pediatrics and the American Heart Association has been a prominent leader of neonatal resuscitation develop-ment and is now in its third decade. The NRP, along with other neonatal resuscitation programs, has been taught in

1. Foundations of Neonatal Resuscitation 2. Preparing for Resuscitation 3. Initial Steps of Newborn Care 4. Positive-pressure Ventilation 5. Alternative Airways 6. Chest Compressions 7. Medications 8. Post-resuscitation Care 9. Resuscitation and Stabilization of Babies Born Preterm 10. Special Considerations 11. Ethics and Care at the End of Life

related neonatal deaths (RR 0.70, 95%CI 0.59-0.84); this estimate was used for the effect of facility-based basic neonatal resuscitation (additional to stimulation). The evidence for preterm mortality effect was low quality and thus expert opinion was sought. In community-based studies, resuscitation

Part 11: Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recom-mendations. Resuscitation 2010;81:e260–e287. Corresponding author at: The James

Part 13: Neonatal Resuscitation Web-based Integrated 2010 & 2015 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care 1 Highlights & Introducti

Modern Approaches to Management *Separated Bureaucracy from Classical School. Lawal (2012) 1. Classical School of Management 2. Organic or Neo-Classical School (Human Relations and Behavioural Theories) 3. System and Contingency School 4. Dynamic Engagement Era * Agreed with Stoner et al. (2004) by Identifying New School (No. 4) Robbins and Coulter (2009) 1. Classical Approach 2. Quantitative .