Neonatal Resuscitation Program (NRP)
Evidenced-based Updates
Volume/Issue 27 Number (No) 2 Fall/Winter 2018
Updated: December 24, 2018; Published: December 24, 2018
Suctioning: Who, When and Why?
Palm Desert Resuscitation Education (PDRE) and the Neonatal Resuscitation Program (NRP) Steering Committee have been following diligently the steady stream of NRP Instructor Updates for the Fall and Winter Seasons of 2018. These fresh revised guidelines and recommendations for “Newborn Resuscitation” obviously come from the Members of the NRP Steering Committee and the American Heart Association (AHA) developed the 2015 United States (U.S.) Guidelines for Neonatal Resuscitation. The most recent guidelines are also reprinted in the appendix of the Textbook of Neonatal Resuscitation, 7th edition. Palm Desert Resuscitation Education (PDRE) and the NRP education materials via these scholarly provider manuals translate these prominent guidelines and recommendations into medical and clinical practice.
For instance, the NRP Steering Committee receives many questions about the current recommendation for suctioning the newborn at birth. This is actually Part 1 of a three-part series regarding newborn suctioning in the delivery room.
The Obstetric Provider and Newborn Suctioning: When the Amniotic Fluid is Meconium-stained
In the past, obstetric management of the meconium-stained newborn included procedures that were meant to reduce the risk of meconium aspiration syndrome (MAS). These procedures have historically included tracheal suction of vigorous and non-vigorous newborns and suctioning the hypo-pharynx before delivery of the shoulders (intrapartum suction). While intrapartum suctioning and tracheal suctioning of the vigorous newborn have not been recommended since the 2010 Guidelines, the 2015 Guidelines stated there was insufficient evidence to continue routine tracheal suctioning for non-vigorous babies born through meconium-stained amniotic fluid. A definitive randomized controlled trial is still needed.
In 2017, the American College of Obstetricians and Gynecologists (ACOG) published Committee Opinion Number 689 that concurred with the 2015 U.S. Guidelines for Neonatal Resuscitation. The American Academy of Pediatrics (AAP), AHA and ACOG agreed that non-vigorous meconium-stained babies should be moved to the radiant warmer for initial steps and be resuscitated in the same manner as babies with clear amniotic fluid. Implications for not transferring the neonatal baby to the radiant warmer quickly after birth – whether having risk factors or not necessitating neonatal resuscitations dependent on the amount of babies being delivered, gestation age, amniotic fluid consistency and make-up, and perinatal risk factors – may include mild (temperature between 36 C and 36.4 C or 98.6 F and 97.6 F), moderate (temperature between 32 C and 35.9 C or 89.6 F and 96.6 F), and severe (temperature between less than 32 C or less than 89.6 F) hypothermia due to the neonate’s inefficient thermoregulation system and jeopardy for hypothermia and cold stress syndrome which may lead to heat loss, increase in metabolic heat production, tissue hypoxia and neurologic damage with possible cardiorespiratory compromise needing neonatal resuscitation.
When the Amniotic Fluid is Clear
The current Textbook of Neonatal Resuscitation, 7th edition recommends bulb suction as part of the initial steps of newborn care if the newborn is having difficulty clearing the airway, if secretions are obstructing the airway, or if the baby is apneic or gasping and PPV is anticipated. Intrapartum suctioning is not ever recommended.
If a baby is unexpectedly born limp and apneic and the obstetric provider had planned to delay cord clamping, it is reasonable to quickly bulb suction the newborn’s mouth and nose and gently stimulate the baby to breath following delivery of the baby. If the baby does not begin to breathe immediately, the umbilical cord should be clamped and cut, and the baby moved to the radiant warmer for the initial steps of newborn care and further evaluation.
NRP Online Exam – Test Your Knowledge
After chest compressions with coordinated ventilations are started, the heart rate should be assessed:
- After 60 seconds
- After 30 seconds
- After 90 seconds
- When spontaneous respirations return
Answer to NRP Online Exam – Test Your Knowledge
The correct answer is: A. After 60 seconds
The heart rate should be assessed after 60 seconds of continuous chest compressions with coordinated ventilations in 100% oxygen.
Studies have shown that it may take a minute or more for the heart rate to increase after compressions are started. When compressions are stopped coronary artery perfusion is decreased and requires time to recover once compressions are resumed. Therefore, it is recommended that you provide 60 seconds of well-coordinated chest compressions and ventilation before briefly pausing compressions to assess the heart rate.
A cardiac monitor is the preferred method for assessing heart rate when chest compressions are required. Auscultation with a stethoscope can be difficult, prolonging the interruption in compressions, and potentially yield inaccurate results. A pulse oximeter may not reliably detect the baby’s pulse, especially when the baby’s perfusion is very poor.
Resources:
- 2015 AHA Guidelines Update for CPR and ECC – CERCP
- The American College of Obstetricians and Gynecologists (ACOG) Committee Opinion on Obstetric Practice – Number 767 (Replaces Committee Opinion Number 692) – MS NO: ONG-18-2174
Disclaimer:
Statements and opinions expressed in this publication are those of the authors of Palm Desert Resuscitation Education LLC (PDRE) and are not necessarily those of the American Academy of Pediatrics (AAP) or American Heart Association (AHA).
PDRE Pricing And Purchasing Options
As an authorized American Heart Association (AHA) training site, PDRE follows the authority in resuscitation science, research and training as published in the official AHA Guidelines for CPR and Emergency Cardiovascular Care (ECC). Our competent and experienced instructors interpret these Guidelines into the most premier quality training courses and programs in CPR, first aid and advanced emergency cardiovascular care for healthcare professionals, first responders, employees and the general public. We thank you for selecting PDRE as your preferred authorized AHA training site in Southern California.
This is a full listing of classroom-based and online courses as well as other services and products that PDRE offers. Please click on the specific course and program or services to view the full details and purchase options.
GROUP CLASSROOM-BASED COURSE
AND PROGRAM CATALOG
- Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
GROUP CLASSROOM-BASED COURSE AND PROGRAM CATALOG | INITIAL | RENEWAL |
---|---|---|
ACLS for Healthcare Providers | ||
ACLS – Advanced Cardiovascular Life Support | ||
Classroom-based course
|
$280 | $200 |
2015 ACLS Provider Manual or 2015 Handbook for ECC | $50 | $50 |
Total for the course and book | $330 | $250 |
PALS for Healthcare Providers | ||
PALS – Pediatric Advanced Life Support | ||
Classroom-based course
|
$280 | $200 |
2015 PALS Provider Manual | $50 | $50 |
Total for the course and book | $330 | $250 |
BLS – Basic Life Support | ||
BLS for Healthcare Providers (English & Spanish) | ||
Classroom-based course | $50 | $45 |
2015 BLS Provider Manual | $25 | $25 |
Total for the course and book | $70 | $65 |
Workplace Training | ||
Heartsaver® Bloodborne Pathogens | ||
Classroom-based course | $65 | $65 |
2015 Heartsaver Bloodborne Pathogens Workbook (required) | $15 | $15 |
Total for the course and book | $80 | $80 |
Heartsaver® First Aid (English & Spanish) | ||
Classroom-based course | $75 | $75 |
2015 Heartsaver First Aid Provider Manual | $10 | $10 |
Total for the course and book | $85 | $85 |
Heartsaver® CPR AED (ENGLISH & SPANISH) | ||
Classroom-based course | $75 | $75 |
2015 Heartsaver CPR AED Provider Manual | $10 | $10 |
Total for the course and book | $85 | $85 |
Heartsaver® First Aid CPR AED (English & Spanish) | ||
Classroom-based course | $110 | $110 |
2015 Heartsaver First Aid CPR AED Provider Manual | $10 | $10 |
Total for the course and book | $120 | $120 |
Heartsaver® First Aid CPR AED for K-12 Students, Faculty, & Staff |
||
Classroom-based course | $110 | $110 |
Heartsaver First Aid CPR AED Provider Manual | $10 | $10 |
Total for the course and book | $120 | $120 |
Heartsaver® Health & Safety Training | ||
Classroom-based course | $225 | $210 |
2015 Heartsaver® Health & Safety Training Manual (optional) | $25 | $25 |
Total for the course and book | $250 | $235 |
Heartsaver® Pediatric First Aid CPR AED (English & Spanish) | ||
Classroom-based course | $110 | $110 |
2015 Heartsaver First Aid Provider Manual | $10 | $10 |
Total for the course and book | $120 | $120 |
Airway Management | ||
Classroom-based course |
$125 |
$150 |
ECG & Pharmacology Course | ||
Classroom-based course | $145 | $145 |
ECG & Pharmacology Student Workbook (optional) | $25 | $25 |
Total for the course and book | $170 | $170 |
Neonatal Resuscitation Program (NRP) for Healthcare Providers |
||
Classroom-based course
|
$135 | $135 |
Textbook of Neonatal Resuscitation, 7th Edition (required) | $70 | $70 |
Total for the course and book | $205 | $205 |
Pediatric Emergency Advanced Assessment, Recognition and Stabilization (PEARS) | ||
Classroom-based course without the provider manual (required) | $150 | $125 |
Sugar, Temperature, Airway, Blood Pressure, Lab Work, and Emotional Support (S.T.A.B.L.E.) Program | ||
Classroom-based course | $120 | $100 |
The S.T.A.B.L.E. Program Learner and Provider Manual, 6th Edition | $65 | $65 |
Total for the course and book | $185 | $165 |
Management of Assaultive Behavior (MAB)/AB-508 Violence Prevention | ||
Classroom-based course | $70 | $65 |
PDRE’s Dog Lovers First Aid and CPR/CPCR Course | ||
Classroom-based course | $70 | $65 |
Intravenous (IV) Therapy & Blood Withdrawal Certification by Palm Desert Resuscitation Education LLC (PDRE) & Replenish 360 (R360) IV Hydration Therapy (OPEN FOR ENROLLMENT NOW!)
Classroom-based course
|
$280 | $200 |
Preventive Health & Safety Practices (PHSP) Training Program For Child Care Providers
Classroom-based course |
$225
$120 $105 |
$225
$120 $105 |
CERTIFIED NURSE ASSISTANT (CNA)/NURSE ASSISTANT TRAINING PROGRAM (NATP) CURRICULUM BY SOUTHERN CALIFORNIA NURSING ACADEMY, INC. (SOCAL NURSING)
Classroom-based course
|
$2,350
$1,175 $783.33 |
$2,350
$1,175 $783.33 |
PRIVATE CLASSROOM-BASED COURSE
AND PROGRAM CATALOG
- Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
- Private classroom-based courses charges may vary on season, location, and scheduling.
- Private ACLS classroom-based courses = Additional $50 Fee
- Private BLS classroom-based courses = Additional $30 Fee
- Private Heartsaver classroom-based courses = Additional $30 Fee
- Please call us to verify any extra fees and charges for private classroom-based courses at (760) 832-4277 or (909) 809-8199; email us at [email protected]; or fill out our questionnaire on our Locations & Contact Us informational page.
PRIVATE CLASSROOM-BASED COURSE AND PROGRAM CATALOG | INITIAL | RENEWAL |
---|---|---|
ACLS for Healthcare Providers | ||
ACLS – Advanced Cardiovascular Life Support | ||
Classroom-based course
|
$300 | $280 |
2015 ACLS Provider Manual or 2015 Handbook for ECC | $50 | $50 |
Total for the course and book | $350 | $330 |
PALS for Healthcare Providers | ||
PALS – Pediatric Advanced Life Support | ||
Classroom-based course
|
$300 | $280 |
2015 PALS Provider Manual | $50 | $50 |
Total for the course and book | $350 | $330 |
BLS – Basic Life Support | ||
BLS for Healthcare Providers (English & Spanish) | ||
Classroom-based course | $150 | $130 |
2015 BLS Provider Manual | $25 | $25 |
Total for the course and book | $175 | $155 |
Workplace Training | ||
Heartsaver® Bloodborne Pathogens | ||
Classroom-based course | $110 | $105 |
2015 Heartsaver Bloodborne Pathogens Workbook (optional) | $15 | $15 |
Total for the course and book | $125 | $120 |
Heartsaver® CPR AED (ENGLISH & SPANISH) | ||
Classroom-based course | $120 | $120 |
2015 Heartsaver CPR AED Provider Manual | $10 | $10 |
Total for the course and book | $130 | $130 |
Heartsaver® First Aid CPR AED for K-12 Students, Faculty, & Staff |
||
Classroom-based course | $155 | $155 |
Heartsaver First Aid CPR AED Provider Manual | $10 | $10 |
Total for the course and book | $165 | $165 |
Heartsaver® Health & Safety Training | ||
Classroom-based course | $225 | $210 |
2015 Heartsaver® Health & Safety Training Manual (optional) | $25 | $25 |
Total for the course and book | $250 | $235 |
Heartsaver® Pediatric First Aid CPR AED (English & Spanish) | ||
Classroom-based course | $155 | $155 |
2015 Heartsaver First Aid CPR AED Provider Manual | $10 | $10 |
Total for the course and book | $165 | $165 |
Airway Management | ||
Classroom-based course |
$125 |
$150 |
ECG & Pharmacology Course | ||
Classroom-based course | $145 | $145 |
ECG & Pharmacology Student Workbook (optional) | $25 | $25 |
Total for the course and book | $170 | $170 |
Neonatal Resuscitation Program (NRP) for Healthcare Providers |
||
Classroom-based course
|
$135 | $135 |
Total for the course and book | $205 | $205 |
Pediatric Emergency Advanced Assessment, Recognition and Stabilization (PEARS) | ||
Classroom-based course without the provider manual (required) | $150 | $125 |
Sugar, Temperature, Airway, Blood Pressure, Lab Work, and Emotional Support (S.T.A.B.L.E.) Program | ||
Classroom-based course | $120 | $100 |
The S.T.A.B.L.E. Program Learner and Provider Manual, 6th Edition | $65 | $65 |
Total for the course and book | $185 | $165 |
Management of Assaultive Behavior (MAB)/AB-508 Violence Prevention | ||
Classroom-based course | $70 | $65 |
PDRE’s Dog Lovers First Aid and CPR/CPCR Course | ||
Classroom-based course | $70 | $65 |
Intravenous (IV) Therapy & Blood Withdrawal Certification by Palm Desert Resuscitation Education LLC (PDRE) & Replenish 360 (R360) IV Hydration Therapy (OPEN FOR ENROLLMENT NOW!)
Classroom-based course
|
$280 | $200 |
Preventive Health & Safety Practices (PHSP) Training Program For Child Care Providers
Classroom-based course |
$225
$120 $105 |
$225
$120 $105 |
CERTIFIED NURSE ASSISTANT (CNA)/NURSE ASSISTANT TRAINING PROGRAM (NATP) CURRICULUM BY SOUTHERN CALIFORNIA NURSING ACADEMY, INC. (SOCAL NURSING)
Classroom-based course
|
$2,350
$1,175 $783.33 |
$2,350
$1,175 $783.33 |
ONLINE COURSE AND PROGRAM CATALOG
- Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
ONLINE COURSE AND PROGRAM CATALOG | INITIAL | RENEWAL |
---|---|---|
Courses for Healthcare Professionals | ||
Acute Stroke (Online) | ||
Online course only with Access Key | $60 | $55 |
Nonvalvular Atrial Fibrillation (Online) | ||
Online course only with Access Key | $60 | $55 |
Workplace Training | ||
Heartsaver® Bloodborne Pathogens (Online) | ||
Online course only with Access Key | $70 | $70 |
Skills Tests only (optional) | $35 | $35 |
Bundle package ($10 Savings!)
|
$95* | $95* |
Heartsaver® First Aid (Online Part 1) And Skills Tests | ||
Heartsaver® First Aid (Online Part 1) And Skills Tests | $80 | $80 |
Heartsaver® First Aid Skills Tests (Only if Online Part 1 is Complete) | $40 | $40 |
Heartsaver® First Aid (Online Part 1) | $40 | $40 |
Heartsaver® CPR AED (Online Part 1) And Skills Tests | ||
Heartsaver® CPR AED (Online Part 1) And Skills Tests | $90 | $90 |
Heartsaver® CPR AED Skills Tests (Only if Online Part 1 is Complete) | $50 | $50 |
Heartsaver® CPR AED (Online Part 1) | $40 | $40 |
Heartsaver® Health & Safety Training | ||
Online course only with Access Key | N/A | N/A |
Skills Tests only | N/A | N/A |
Bundle package
|
N/A | N/A |
Heartsaver® Pediatric First Aid CPR AED (Online Part 1) And Skills Tests
Heartsaver® First Aid CPR AED (Online Part 1) and Skills Tests |
||
Heartsaver® (Adult/Pediatric) First Aid CPR AED (Online Part 1) And Skills Tests | $110 | $110 |
Heartsaver® (Adult/Pediatric) First Aid CPR AED (Online Part 1) Skills Tests Only | $60 | $60 |
Heartsaver® (Adult/Pediatric) First Aid CPR AED (Online Part 1) | $50 | $50 |
HeartCode® ACLS (Online Part 1) and Skills Tests | ||
ACLS – Advanced Cardiovascular Life Support | ||
HeartCode® ACLS (Online Part 1) and Skills Tests | $250 | $250 |
HeartCode® ACLS (Online Part 1) Skills Tests Only | $150 | $150 |
HeartCode® ACLS (Online Part 1) | $100 | $100 |
HeartCode® PALS (Online Part 1) And Skills tests | ||
PALS – Pediatric Advanced Life Support | ||
HeartCode® PALS (Online Part 1) and Skills Tests | $250 | $250 |
HeartCode® PALS Skills Tests Only | $150 | $150 |
HeartCode® PALS (Online Part 1) | $100 | $100 |
HeartCode® BLS for Healthcare Providers (Online Part 1) And Skills Tests | ||
BLS – Basic Life Support | ||
BLS for Healthcare Providers (Online Part 1) and Skills Tests | $90 | $90 |
BLS for Healthcare Providers Skills Tests Only | $50 | $50 |
BLS for Healthcare Providers (Online Part 1) | $40 | $40 |
HeartCode® BLS (Online Part 1) |
||
HeartCode® BLS (Online Part 1) and Skills Tests | $90 | $90 |
HeartCode® BLS Skills Tests Only | $50 | $50 |
HeartCode® BLS (Online Part 1) | $40 | $40 |
Learn:® Rhythm Adult (Online) | ||
Online course only with Access Key | $70 | $65 |
Learn:® Rhythm Pediatric (Online) | ||
Online course only with Access Key | $60 | $55 |
Learn:® Rapid STEMI ID (Online) | ||
Online course only with Access Key | $70 | $65 |
PROVIDER MANUALS
- Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
PROVIDER MANUALS | PRICE |
---|---|
2015 HEARTSAVER FIRST AID PROVIDER MANUALS |
$10 |
2015 HEARTSAVER CPR AED PROVIDER MANUALS |
$10 |
2015 HEARTSAVER FIRST AID CPR AED PROVIDER MANUALS |
$10 |
2015 HEARTSAVER PEDIATRIC FIRST AID CPR AED PROVIDER MANUALS |
$10 |
2015 BLS PROVIDER MANUALS |
$25 |
2015 ACLS PROVIDER MANUALS |
$50 |
2015 EMERGENCY CARDIOVASCULAR CARE (ECC) HANDBOOK |
$50 |
2015 PALS PROVIDER MANUALS |
$60 |
2015 PEARS PROVIDER MANUAL |
$60 |
THE S.T.A.B.L.E. PROGRAM, LEARNER/PROVIDER MANUAL 6th EDITION |
$65 |
TEXTBOOK OF NEONATAL RESUSCITATION (NRP) 7th EDITION |
$70 |
Note: Reference Cards Guides are also available upon request for purchase(s).
Note: Electronic Manuals in the form of E-Books are also available upon request for purchase(s). |
Price may vary |
OTHER PRODUCTS
- Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
OTHER PRODUCTS | PRICE |
---|---|
Emergency Disposable CPR Face Shield | $1 |
Adhesive Vinyl Hard Hat Decal, Legend “CPR FIRST AID CERTIFIED AND TRAINED” (Graphic, 2-1/4″ Diameter, White on Red) |
$2.50 |
Pocket Reference Card (for all of the disciplines) |
$12 |
Adult CPR Pocket Resuscitator Mask |
$15 |
Adult Ambu Bag (Bag Valve Mask/Device) |
$40 |
Pediatric Ambu Bag (Bag Valve Mask/Device) |
$45 |
OTHER SERVICES
- Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
SERVICES | Price |
---|---|
Automated External Defibrillator (AED) Service Package for your Business or Home Each AED Purchase + Standard Cabinet with Alarm |
|
Philips HeartStart Home Defibrillator (AED)
|
$1,300 |
Labor and Installation Fee at your location
|
$150 |
Monthly AED Service Support Fee (Optional)
|
$30/month $250/year |
Classroom Based CPR Classes, First Aid, BLS, ACLS, and PALS Certification and Recertification Courses available for surrounding Palm Desert cities:
|
WEST FROM PDRE Redlands (92373, 92374, 92375) Morongo Valley (92256) Cabazon (92230) Banning (92220) Beaumont (92223) Yucaipa (92399) San Jacinto (92581, 92582, 92583) Hemet (92543, 92544, 92545, 92546) Temecula (92589, 92590, 92591, 92592, 92593) NORTH FROM PDRE Twentynine Palms (92277, 92278) Yucca Valley (92284, 92286) Big Bear Lake (92315) |
EAST FROM PDRE Joshua Tree (92252) Salton Sea (92275) Brawley (92227) El Centro (92243, 92244) Blythe (92225, 92226) Calexico (92231, 92232) SOUTH FROM PDRE Borrego Springs (92004) Anza (92539) |
Classroom Based CPR Classes, First Aid, BLS, ACLS, and PALS Certification and Recertification Courses available for surrounding Redlands area cities:
|
|
Classroom Based CPR Classes, First Aid, BLS, ACLS, and PALS Certification and Recertification Courses available for surrounding Riverside cities:
|
|
Classroom Based CPR Classes, First Aid, BLS, ACLS, and PALS Certification and Recertification Courses available for surrounding Orange County and Lake Forest cities:
|
|
Classroom Based CPR Classes, First Aid, BLS, ACLS, and PALS Certification and Recertification Courses available for surrounding San Diego cities:
|
|
|
WEST FROM PDRE Redlands (92373, 92374, 92375) Morongo Valley (92256) Cabazon (92230) Banning (92220) Beaumont (92223) Yucaipa (92399) San Jacinto (92581, 92582, 92583) Hemet (92543, 92544, 92545, 92546) Temecula (92589, 92590, 92591, 92592, 92593)NORTH FROM PDRE Twentynine Palms (92277, 92278) Yucca Valley (92284, 92286) Big Bear Lake (92315) |
EAST FROM PDRE Joshua Tree (92252) Salton Sea (92275) Brawley (92227) El Centro (92243, 92244) Blythe (92225, 92226) Calexico (92231, 92232)SOUTH FROM PDRE Borrego Springs (92004) Anza (92539) |