Continuing Education Resource


NRP 8th Edition Practice Changes


Umbilical cord management plan added to 4 prebirth questions, replacing “How many babies?” with “Umbilical cord management plan?” The new 4 pre-birth questions: (1) Gestational age? (2) Amniotic fluid clear? (3) Additional risk factors? (4) Umbilical cord management plan?


Initial steps reordered to better reflect common practice. ‘Maintain normal temperatures” has been removed. Current Initial steps: Warm, dry, stimulate, position airway, suction if needed.


An electronic cardiac monitor is recommended earlier in the algorithm From “An electronic cardiac monitor is the preferred method for assessing heart rate during cardiac compressions” it is changed to “When an alternative airway becomes necessary, a cardiac monitor is recommended for the most accurate assessment of the baby’s heart rate.”


Epinephrine intravenous/intraosseous (IV/IO) flush volume increased. “From 0.5 to 1 mL normal saline flush with 3 mL normal saline (applies to all weights and gestational ages).


Epinephrine IV/IO and endotracheal doses have been simplified for educational efficiency. The suggested new initial IV or IO dose = 0.02 mg/kg (equal to 0.2 mL/kg). The suggested endotracheal dose (while establishing vascular access) = 0.1 mg/kg (equal to 1 mL/kg)


Expanded timeframe for cessation of resuscitative efforts Current recommendation - If confirmed absence of HR after all appropriate steps performed, consider cessation of resuscitation efforts around 20 minutes after birth (decision individualized on patient and contextual factors) . Bar graph of CCANN membership from year 2008 - 2021