Epinephrine IV/IO
0.065 mg · 0.65 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.
Nursery/SCN · NRP 9th Ed
Neonatal Resuscitation & Lines
NRP 9th Edition
Resuscitation doses, setup & APGAR
PRE-DELIVERY ESTIMATE · 38 wk GA median ≈ 3.25 kg — re-verify on weighing. Enter actual or ultrasound weight above when known.
Normal saline IV (0.9% NaCl)
32.5 mL
10 mL/kg IV over 5–10 min (NRP 9th Ed chart) for suspected hypovolemia; reassess before any repeat.
Epinephrine endotracheal
0.325 mg · 3.25 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.
Initial FiO₂
21%
≥35 wk 21% · 32–34 wk 21–30% · <32 wk ≥30%. Titrate to preductal SpO₂; 100% O₂ during compressions.
Initial PIP
25 cm H₂O
Range 25–30 cm H₂O (≥32 wk) · PEEP 5 cm H₂O · rate 30–60/min · gas flow 10 L/min.
ETT tip-to-gum depth
8.5 cm
NRP 9th Ed chart, 38–40 wk. Confirm CO₂ detection, chest rise and position.
ETT by gestation
3.5 mm uncuffed
NRP 9th Ed chart (38–40 wk ≈ 2.5–3.1 kg).
Thermal plan
Prewarmed warmer · dry
Dry, remove wet linen, hat; maintain 36.5–37.5 °C.
Neonatal ETT (by weight)
3.5 mm uncuffed
NRP 9th Ed chart: 3.2–4.2 kg → 3.5 mm; tip-to-gum 9.0 cm (41–43 wk). Verify with gestational age.
UVC depth (supplemental)
10.4 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)
18.8 cm Shukla · 20.0 cm Wright
Shukla 3 × kg + 9; Wright 4 × kg + 7. Not on NRP chart; confirm T6–T9 by imaging.
Catheter / OG (supplemental)
5 Fr lines · OG 21.8 cm
OG (3 × kg) + 12 cm. Local practice varies; verify against unit policy.
Epinephrine 0.1 mg/mL only. UVC preferred; IO alternative. CPR 3:1 (90 compressions + 30 breaths/min) with 100% O₂. MR. SOPA: M Mask adjustment · R Reposition head · S Suction mouth/nose · O Open mouth · P Pressure increase · A Alternative airway.
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.
Section A
Endotracheal Tube (ETT) Selector
Source: AAP/AHA NRP 9th Edition Reference Chart
| Gestation | Tip-to-gum depth | Weight | ET size (ID) |
|---|---|---|---|
| <23 wk | 5.0–5.5 cm | <0.5 kg | 2.5 mm (2.0*) |
| 23–24 wk | 5.5 cm | 0.5–0.6 kg | 2.5 mm (2.0*) |
| 25–26 wk | 6.0 cm | 0.7–0.8 kg | 2.5 mm (2.0*) |
| 27–29 wk | 6.5 cm | 0.9–1.0 kg | 2.5 mm |
| 30–32 wk | 7.0 cm | 1.0–1.4 kg | 2.5–3.0 mm |
| 33–34 wk | 7.5 cm | 1.5–1.8 kg | 3.0 mm |
| 35–37 wk | 8.0 cm | 1.9–2.4 kg | 3.0–3.5 mm |
| 38–40 wk | 8.5 cm | 2.5–3.1 kg | 3.5 mm |
| 41–43 wk | 9.0 cm | 3.2–4.2 kg | 3.5 mm |
*A 2.0 mm ID endotracheal tube (optional) may be considered. Table transcribed from the NRP 9th Edition Reference Chart.
Section B
Umbilical Vessel Catheterization (UAC / UVC)
Sources: Shukla & Wright (UAC) · Revised Shukla / Verheij (UVC)
Secondary Verification
OG Tube — NEX Measurement
Measure from the tip of the Nose, to the Earlobe, to the Xiphoid process (NEX). Use this physical length as a bedside cross-check against the (3 × wt) + 12 cm depth above before securing the tube.
Alternative Surface Anatomy Sizing (Morphometric Guides)
- UVC Surface Depth = Umbilicus-to-Nipple distance (UN) − 1 cm
- UAC Surface Depth = (UN − 1 cm) + (2 × Umbilicus-to-Symphysis Pubis distance)
Clinical Safety Check: Catheter malposition rates remain at 25–60% initially. Always verify tip positioning immediately via radiographic confirmation or Point-of-Care Ultrasound (POCUS) to avoid hepatic portal circulation (UVC) or mesenteric/renal artery branching (UAC).
ETT size and tip-to-gum depth per NRP 9th Edition Reference Chart. Umbilical/OG formulas below are supplemental (not on the NRP chart) — UAC: Shukla (3×wt + 9) or Wright (4×wt + 7). UVC: [(3×wt + 9)/2] + 1 cm. OG depth: (3×wt) + 12 cm. Confirm placement radiographically. For clinical decision support only.