Epinephrine IV/IO
— mg · — mL
0.02 mg/kg reference dose · 0.1 mg/mL · repeat every 3–5 min if HR <60. Guideline range 0.01–0.03 mg/kg.
Code · Resuscitation
Emergency Resuscitation Code
3:1
Coordinated compressions : ventilation
NRP is the birth-transition pathway; age or low weight alone does not determine the resuscitation protocol.
Verification required. Clinical decision support only, not a medication order. Confirm patient, actual weight, concentration, route and institutional protocols. NRP workflow follows your supplied 9th edition document; doses and detailed timing use supplemental AHA/AAP guidance.
Date & time of birth
Date of Birth
Time of Birth
Enter birth date and time to calculate age.
Initiate the cord plan at birth. Do not delay indicated ventilation; cord milking is not a universal substitute for deferred clamping.
Immediate delivery triage
APGAR scores
Score at 1 and 5 minutes. If the 5-minute score is < 7, continue every 5 minutes up to 20 minutes. Use the checklist or type a total. Never delay resuscitation to assign a score.
Record 1- and 5-minute scores.
NRP 9th edition · Birth-to-resuscitation pathway
- Prepare and initiate cord management
Antenatal counseling, team briefing and equipment check. At birth: term gestation? Good tone? Breathing or crying? If all yes: skin-to-skin, routine care, normal temperature and ongoing evaluation.
- Initial steps · first minute
If any answer is no: warm, maintain normal temperature, dry, position and stimulate. Clear the airway only if needed. Apnea/gasping OR HR <100/min: initiate ventilation. Labored breathing/persistent cyanosis without these triggers: pulse oximetry, oxygen as needed, consider CPAP.
- Ventilation (PPV)
30–60 breaths/min. Suggested initial PIP 25 cm H₂O; acceptable range ≥32w: 25–30 · <32w: 20–25 cm H₂O. Initial FiO₂: ≥35w: 21% · 32–34w: 21–30% · <32w: ≥30%. Apply right-hand/wrist preductal pulse oximetry; consider cardiac monitor. Titrate oxygen to saturation targets.
- Assess effectiveness · 15–30 seconds
If HR is not increasing and there is no chest movement, perform ventilation corrective steps. If HR remains <100/min, correct ventilation, consider intubation/laryngeal mask and use a cardiac monitor. Reassess after at least 30 seconds of ventilation that moves the chest.
- HR <60/min despite effective ventilation
Intubate or use a laryngeal mask; coordinate compressions and ventilation 3:1, with 100% oxygen. Two-thumb encircling technique; depth ⅓ chest AP diameter. Aim for 90 compressions + 30 breaths/min. Establish UVC or IO access.
- HR still <60/min after 60 seconds of coordinated CPR
Give IV/IO epinephrine; repeat every 3–5 minutes if HR remains <60/min. Continue effective ventilation and compressions. Consider hypovolemia and pneumothorax. HR ≥60: stop compressions, continue ventilation until HR ≥100 with adequate breathing; titrate oxygen and provide post-resuscitation care, family communication and team debrief.
MR. SOPA · Ventilation corrective steps
NRP 9th edition permits the order most likely to help; do not delay an effective airway.
M
Mask adjustment
Re-establish a seal; consider a two-handed mask hold.
R
Reposition head
Position the head to open the airway.
S
Suction mouth/nose
Clear suspected airway obstruction; do not routinely suction.
O
Open mouth
Open the mouth and lift the jaw.
P
Pressure increase
Increase inflation pressure gradually until effective chest movement and rising HR.
A
Alternative airway
Consider an endotracheal tube or laryngeal mask; confirm effective ventilation.
Target preductal SpO₂
- 1 min
- 60–65%
- 2 min
- 65–70%
- 3 min
- 70–75%
- 4 min
- 75–80%
- 5 min
- 80–85%
- 10 min
- 85–95%
Neonatal doses & fluids
Normal saline IV (0.9% NaCl)
— mL
10 mL/kg IV over 5–10 min (NRP 9th Ed chart) for suspected hypovolemia; reassess before any repeat.
Epinephrine endotracheal
— mg · — mL
0.1 mg/kg (1 mL/kg) of 0.1 mg/mL while IV/IO access is obtained · guideline range 0.05–0.1 mg/kg. Give IV/IO dose as soon as access is available.
All epinephrine uses 0.1 mg/mL (1 mg/10 mL), not 1 mg/mL. IV/IO: rapid push, flush 3 mL NS. ETT: 0.1 mg/kg rapid push, no flush, give PPV breaths. UVC is preferred access; IO is an alternative. No routine neonatal bicarbonate or defibrillation.
Airway equipment
Airway & ventilation
Neonatal ETT (by weight)
— mm
Enter weight.
Umbilical lines & OG · supplemental, not on NRP chart
UVC depth (supplemental)
— cm
[(3 × kg + 9) ÷ 2] + 1 cm. Low-lying emergency UVC: insert only 2–4 cm until blood return. Not on NRP chart; confirm by imaging.
High UAC depth (supplemental)
— cm Shukla · — cm Wright
Shukla 3 × kg + 9; Wright 4 × kg + 7. Not on NRP chart; confirm T6–T9 by imaging.
Catheter / OG (supplemental)
—
OG (3 × kg) + 12 cm. Local practice varies; verify against unit policy.