NRP

Instructor Update

VOL 21 NO 2 fall /w in t e r 2 0 1 2

Neonatal Resuscitation:
Right Care, Right Time,
Every Time, Regardless
of Place
Right care, right time, right place is a familiar phrase for health care reform. Because
newborns are not always born at the right place, the Neonatal Resuscitation Program (NRP)
could revise these words to state right care, right time, every time, regardless of place.

he Textbook of Neonatal Resuscitation discusses

management of infants born outside the hospital.
As stated in the 6th edition: Although scenarios encountered
outside the delivery room may be different from the events in the
immediate post-delivery period, the physiologic principles and the
steps you take to restore vital signs remain the same throughout
the neonatal period. The priority for resuscitating babies at any
time during the newborn period, regardless of location, should
be to restore adequate ventilation. Once adequate ventilation is
ensured, consider any available information about the babys
history to guide the focus of your resuscitation efforts (page 256).
The physiological principles and the steps taken are the same
whether inside or outside the hospital. Is access to the Neonatal
Resuscitation Program (NRP) the same? Even the best transport
capability will not prevent unplanned births in homes, shopping
centers, on freeways, and in parking lots. Most agree that an
unplanned birth of a newborn outside the hospital delivery room
is not an ideal situation. Although EMS providers have education
programs designed for the unique settings in which they practice,
pre-hospital providers often feel unprepared to deliver quality
care in the immediate postpartum and delivery period. How can
we expect pre-hospital providers to provide the resuscitation
interventions outlined in the NRP if they do not have access to
NRP Provider Courses in the hospital system or region where
they practice?

Most hospitals have a well established system for ensuring that

everyone in maternal-infant care units remains a current NRP
provider. Pre-hospital providers, inter-facility transport providers,
(and in some cases, emergency department staff) may not know
the process for accessing quality Provider Courses within the
hospital. The barriers most often cited are:
u Availability of Courses and Scheduling
Most hospitals schedule their NRP courses around the
participants who require them, education that is already
scheduled and standardized, and unit routines. This offers
much flexibility in scheduling and re-scheduling, if necessary.
Participants often practice in one area of the hospital
and expectations for education are familiar to employees.
Communication is established within the system and no
effort is made to include anyone from outside the neonatal/
perinatal care unit.
u Cost
Within the hospital, the cost of the online examination is usually
a small part of a larger hospital learning system. The cost of
NRP instructors, non-clinical time for participants, and perhaps
even the course equipment and supplies are addressed by the
institutions budgetary resources. There are often no provisions
to include NRP participants from outside the system.

continued on page 6

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NRP Acknowledgements

NRP Editors
John Kattwinkel, MD, FAAP
University of Virginia
Charlottesville, VA

In This Issue

Gary M. Weiner, MD, FAAP

Saint Joseph Mercy Hospital
Ann Arbor, MI

1 Neonatal Resuscitation:
Right Care, Right Time, Every Time,
Regardless of Place

Jeanette Zaichkin, RN, MN, NNP-BC

Seattle Childrens Hospital
Seattle, WA

2 In This Issue/Acknowledgements

NRP Steering Committee Liaisons

Khalid Aziz, MD, FRCPC, FAAP
Canadian Paediatric Society
Royal Alexandra Hospital
Edmonton, AB, Canada

3 Reflections: The Impact of NRP

on Nursing since 1987
4 Give That Baby Some Oxygen!
Dont Say Goodbye to the
Self-Inflating Bag
5 Effective Ventilation Begins Now
7 Meeting NRP Provider Course
Objectives: May I Use the Integrated
Skills Station for Simulation and
Debriefing?

8 2013 NRP Research Grant and

Young Investigator Award Call
for Applications
Whats New with the NRP Exam?

NRP Online Examination Reminder

The Neonatal Resuscitation Program (NRP)

Steering Committee offers the NRP Instructor Update
to all AAP/AHA NRP Instructors.
Editor
Eric C. Eichenwald, MD, FAAP

Jeffrey Perlman, MB, ChB, FAAP

ILCOR Science Director
Liaison AHA Pediatric Subcommittee
New York Presbyterian Hospital
New York, NY

Contributor
Jeanette Zaichkin, RN, MN, NNP-BC

Mildred Ramirez, MD, FACOG

American College of Obstetricians and Gynecologists
Baylor College of Medicine
Houston, TX

NRP Steering Committee

Jane E. McGowan, MD, FAAP, Cochair
Drexel University College of Medicine
Philadelphia, PA

Anne Ades, MD, FAAP

The Childrens Hospital of Philadelphia
Philadelphia, PA

Comments and questions are welcome

and should be directed to:
Eric C. Eichenwald, MD, FAAP
Editor, NRP Instructor Update
141 Northwest Point Blvd., PO Box 927
Elk Grove Village, IL 60009-0927
www.aap.org/nrp
American Academy of Pediatrics/
American Heart Association, 2012

VOL 21 NO 2 fall /w in t e r 2 0 1 2

Patrick McNamara, MB, FRCPC

Canadian Paediatric Society
The Hospital for Sick Children
Toronto, ON, Canada

Managing Editors
Melissa Marx
Rachel Poulin, MPH
Wendy Marie Simon, MA, CAE

Myra H. Wyckoff, MD, FAAP, Cochair

University of Texas Southwestern Medical Center
Dallas, TX

Statements and opinions expressed in

this publication are those of the authors
and are not necessarily those of the
American Academy of Pediatrics or
American Heart Association.

Praveen Kumar, MD, FAAP

AAP Committee on Fetus and Newborn
Northwestern Memorial Hospital
Chicago, IL

Christopher Colby, MD, FAAP

Mayo Clinic
Rochester, MN
Eric C. Eichenwald, MD, FAAP
University of Texas-Houston Medical School
Houston, TX
Kimberly D. Ernst, MD, MSMI, FAAP
University of Oklahoma Health Sciences Center
Oklahoma City, OK
Henry C. Lee, MD, FAAP
University of California-San Francisco
San Francisco, CA
Steven Ringer, MD, PhD, FAAP
Brigham & Womens Hospital
Boston, MA

John Gallagher, RRT-NPS

American Association for Respiratory Care
Rainbow Babies & Childrens Hospital
Cleveland, OH
Linda McCarney, MSN, RN, NNP-BC, EMT-P
National Association of Neonatal Nurses
The Childrens Hospital in Denver
Aurora, CO
NRP Steering Committee Consultants
Louis P. Halamek, MD, FAAP
Stanford University
Palo Alto, CA
Jerry Short, PhD
University of Virginia
Charlottesville, VA
AAP Staff Liaisons
Kristy Crilly
Nancy Gardner
Rory Hand, EdM
Jackie Hughes
Melissa Marx
Kirsten Nadler, MS
Rachel Poulin, MPH
Wendy Simon, MA, CAE

Reflections: The Impact of NRP on Nursing since 1987

I n the mid-1970s, with the emerging prominence of Neonatal Intensive Care Units, it became increasingly

important that community hospitals recognize and provide initial management of infants requiring transfer to
an NICU. At that time, the Drew Postgraduate Medical School in Los Angeles received funds from the National
Institutes of Health (NIH) to provide education regarding the fundamentals of neonatal care to Level
I nurseries. Ron Bloom, MD and Catherine Cropley, RN, MSN created the Neonatal Educational
Program (NEP), a series of modules, slide tapes, and videotapes. Six modules from the NEP
formed the basis of the Neonatal Resuscitation Program (NRP).

n a recent interview, Catherine Cropley recalls the 1987 flight to

New Orleans to present NRP at the AAP National Convention
& Exhibition for the first time. I remember Dr Bloom leaned over
the aisle and told me, Cathy, just be prepared, because this might
be the only time we do the course. Dr Bloom knew that neonatal
resuscitation at that time was based on consensus and opinion,
and if pediatric leaders did not agree with the standardized
recommendations of first edition NRP, the program would die.
NRP was positively received, and the national faculty at that New
Orleans course hit the ground running. NRP now celebrates its
25th year, more than 3 million providers trained, and now offers
the 6th edition of the Textbook of Neonatal Resuscitation.
NRP introduced the concept of a standardized course, designed
to work in any hospital in the United States. More than that,
recalls Cropley, it was a course that recognized the value of every
team member. It was the first time nurses had responsibilities at
a newborn resuscitation. Before NRP, many nurses in community
hospitals could do nothing except stimulate a limp baby and wait
for a physician.
Cropley recalls life before NRP. She remembers that through
the 1970s, most nurses could do only what the physician
requested at a newborn resuscitation. She says, We worked
without any standard protocols and very little equipment. Every
physician wanted different things in different order. We wrote each
physicians preferences in a Kardex (hard copy directory) and tried
to review it before the doctor arrived.

Cropley believes that NRP greatly expanded nursing autonomy

at neonatal resuscitation. Before NRP, nurses had to be very
careful to remain passive and not overstep their boundaries during
resuscitation. But nurses cant sit in the back seat anymore.
Nurses are expected to actively participate in resuscitation,
she noted.
Cropley remembers a turning point a moment when she knew
NRP had transformed nursing roles and responsibilities. The
physician had not had his NRP course yet and was unsuccessfully
trying to ventilate the baby. I stepped up next to him and said,
Here, can I do that? I ventilated the baby and the baby started
to cry. The physician thanked me! Thats when I knew NRP was
changing things for nursing.

Babs Nightengale, a neonatal nurse

practitioner at West Virginia University,
also has a longstanding relationship with
the NRP. Nightengale began as a member of
the NRP national faculty in 1987 and served as
the NRP Steering Committee Liaison for the National
Association of Neonatal Nurses (NANN) from 1997-2010.
Nightengale recalls her first impressions of the program.
Before NRP, the nurse could stimulate the baby, but stepped
aside to let the OB provider or the babys doctor take over. I was
impressed that NRP emphasized team training right from the
beginning. The doctors didnt learn NRP separately from the
nurses, and then teach nurses what to do. The training taught us
that every person played an important role. NRP allowed nurses to
accept a lot more responsibility, because the nurse was present at
the beginning of a resuscitation. Nurses had to be able to perform
initial steps and ventilate. NRP formalized the nurses role in
neonatal resuscitation.
Both Nightengale and Cropley appreciate how NRP training
methods have evolved since 1987. Cropley says,
In 1987, we had the program, but not the tools. Now NRP
has more than a manikin. Weve really kept up with the times.
I wish I was teaching using these amazing methods now.
Nightengale teaches NRP to many different groups. The program
has remained true to the original concept of a standardized
team approach but has also incorporated technology to keep it
interesting. NRP users have stuck with us as weve changed the
program and the methods, and they like the online media, and
a chance to learn through simulation and debriefing. Were way
ahead of other education programs, and the future of NRP is
pretty exciting, she said.
Nightengale was recently reminded of her beginnings with NRP
and how these skills may have impacted other lives. She recalls
resuscitating a depressed meconium-stained newborn in the late
1980s, taking the lead as the neonatal nurse practitioner. This
was a pediatric residents baby, adding extra pressure to the
situation, but I knew what to do, she says. I intubated, suctioned
meconium, and the baby did well. Recently, I was working in our
NICU and a medical student approached me. Remember me?
he said. I am here because of you. He was that baby! That was a
career highlight for me. Thats the face of NRP.

N R P I N STRUCTOR UPDATE

Give That Baby Some Oxygen!

e have about one year of

experience with the 6th edition
NRP curriculum and most instructors
are feeling comfortable with the revised
neonatal resuscitation guidelines.
However, one situation still shakes the
confidence of some NRP instructors and
providers. That is when the term vigorous
newborn, just a few minutes old and
snuggled on moms chest, remains visibly
cyanotic. That baby is blue! a colleague
states loudly. Why dont you give him
some oxygen?

as an NRP resource. In this situation,

consider using this 3-step approach to
reassure parents and inform colleagues
about the recommended intervention.

Some years ago, we would have complied

without question, giving up to 100%
free-flow oxygen until the infant turned
an acceptable shade of pink. Scientific
evidence now recommends a different
practice, and we no longer give free-flow
oxygen to newborns based on visual
perception of cyanosis.

3. Monitor:
Hes 4 minutes old and his saturation
is 78%, which is within his target
range for now. Lets keep the oximeter
on for a few minutes and make sure
he continues to improve.

How can you convey this 2011

recommended practice guideline to your
colleagues who are not yet in the know
without embarrassing them in front of
others? Its tempting to simply state, We
dont do that anymore, but this does not
improve teamwork or build your credibility

1. Acknowledge:
Yes, I agree. The baby looks blue.
2. Inform:
Before giving oxygen, well use the
pulse oximeter to check the babys
oxygen saturation. Hes allowed to
take up to 10 minutes to saturate
in the 90s.

Participants in your NRP Provider course

will usually appreciate hearing this 3-step
approach during discussion and practice
at the Initial Steps Performance Skills
Station. Then create a simple scenario
where a healthcare professional asks the
NRP learner to administer oxygen to a
term, vigorous, and cyanotic newborn.
This provides learners with an opportunity
to practice their 3-step approach and
demonstrate the NRP Key Behavioral Skill
of maintain professional behavior.

Some years ago, we would

have complied without
question, giving up to 100%
free-flow oxygen until 

or

the infant turned an

Hes 4 minutes old and his saturation

is 70%, which is below his target
range for 4 minutes. Lets give him
40% free-flow oxygen* and watch
him closely. We should be able to
decrease the oxygen as he continues
to improve over the next few minutes.

acceptable shade of pink.

*The concentration of free-flow oxygen is dependent on
the clinical situation. Start with an oxygen concentration
above 21% and less than 100%, with the goal of
attaining and maintaining an oxygen saturation in the
target range according to the newborns age in minutes.

Dont Say Goodbye to the Self-Inflating Bag

The self-inflating bag has been the fundamental tool of neonatal
resuscitation for decades. Recently, the T-piece resuscitator has
gained popularity in the delivery room and is the preferred manual
ventilation device in some institutions. The T-piece resuscitator
has the advantage over the self-inflating bag in that it can deliver
free-flow oxygen through the mask and can be used to deliver
consistent pre-set inspiratory pressure and positive end-expiratory
pressures (PEEP). If the self-inflating bag is no longer used for
ventilating infants in your setting, do you still need access to this
classic apparatus?
The answer is yes! Although the self-inflating bag may be considered
an old standby in some hospitals, it has a few advantages over the
T-piece resuscitator that make it an essential device. If you had only
T-piece resuscitators and the hospital compressed gas source failed,
you would be dependent on your finite resource of air tanks for

VOL 21 NO 2 fall /w in t e r 2 0 1 2

ventilating infants in need. In a natural disaster or evacuation,

the T-piece resuscitator would function on tanks while the supply
lasted, but the self-inflating bag is compact and does not require
any compressed gas for use in room air. In addition, if you need to
run to the emergency department, radiology, hospital parking lot,
or any restroom to resuscitate a newborn, your self-inflating bag
can be carried with your additional emergency supplies as fast as
you need to go and will deliver room air positive pressure ventilation
without delay.
Both the T-piece resuscitator and the self-inflating bag have
advantages and disadvantages, but dont say goodbye to your
self-inflating bag. Its beautifully simple, transports to any location
quickly and easily, and performs in situations where the T-piece
resuscitator cannot.

Effective Ventilation Begins Now

esson 3 of the Textbook of Neonatal Resuscitation, 6th edition

is the longest, and according to some learners, includes the
most complex information of the Neonatal Resuscitation Program.
Most instructors spend the majority of practice and discussion
time at the PPV Performance Skills Station because ventilation of
the lungs is the single most important and most effective step in
cardiopulmonary resuscitation of the compromised newborn.
The 6th edition NRP flow diagram differs from the 5th edition flow
diagram in an important way. The 6th edition flow diagram deleted
the 30 second timeline from positive-pressure ventilation to chest
compressions. This is because chest compressions cannot begin
until effective ventilation has been established, and achieving
effective ventilation may take longer than 30 seconds.
Effective ventilation is defined as the presence of bilateral breath
sounds and chest movement. If these 2 criteria are not evident
with face-mask ventilation, the resuscitator initiates ventilation
corrective steps (MR SOPA):
M: Mask adjustment.
R: Reposition airway.
(try again)
S: Suction mouth and nose.
O: Open mouth.
(try again)
P: Pressure increase.
(up to 40cm H20 pressure)

With clear verbal communication, there 

is no confusion about when to assess heart
rate to determine the next steps.
Your institutions NRP instructors and resuscitation leaders
can decide which team member should make this important
announcement. The following demonstrates an example of
closed-loop communication to convey this critical information and
check-back to ensure that the messages have been understood.
Ventilator (initiating PPV): C
 hest movement?
Bilateral breath sounds?
Assistant: No chest movement. No breath sounds.
Ventilator: Im starting corrective steps. Ive readjusted the mask.
Ive repositioned the head. Chest movement? Bilateral
breath sounds?
Assistant: We have chest movement and bilateral breath sounds.

A: Airway alternative.

Ventilator: Thirty seconds of effective ventilation starts now.

Effective positive pressure ventilation (with bilateral breath

sounds and chest movement) should be delivered for 30
seconds before the heart rate is assessed to determine the
next intervention. If after 30 seconds of effective PPV, the
heart rate is less than 60 beats per minute, chest compressions
may begin, accompanied by ventilation with 100% oxygen,
preferably via an endotracheal tube.

Assistant (or whomever has been assigned this task):

Thirty second count starts now.

Teamwork is essential as resuscitators begin PPV and assess the

effectiveness of face/mask ventilation. The person administering
PPV depends on the assistant to auscultate breath sounds and
help assess chest movement, monitor and assist with ventilation
corrective steps if needed, and apply the pulse oximeter. We
have learned, through simulating and debriefing PPV scenarios
in the past year, that it is also helpful for someone on the team
to announce when effective ventilation has begun. If no one
announces Effective ventilation begins now each team member
could have a different idea as to when the 30-second count for
effective ventilation started and when the heart rate assessment
to determine next steps is indicated.

(30 seconds elapse)

Assistant (or person assigned to be the timekeeper):
Thats 30 seconds of effective ventilation. Checking heart rate.
Ventilator: Heart rate?
Assistant: H
 eart rate is 80 bpm and increasing. Baby is 2 minutes
old and saturation is 70%.
Ventilator: Im continuing ventilation. Were in saturation target
range so well continue in room air.
With clear verbal communication, there is no confusion about
when to assess heart rate to determine the next steps. Practice
announcing effective ventilation starts now during mock
codes and NRP courses. This important information improves
communication and teamwork, decreases team members stress,
and may improve neonatal outcome for newborns who require
positive-pressure ventilation at birth.

N R P I N STRUCTOR UPDATE

continued from page 1 

Neonatal Resuscitation: Right Care, Right Time

Stock the hospital library/media center with several NRP

textbooks available for non-hospitalemployees to check out
(with cash deposit to replace the textbook if it not returned;
include cost and shipping of new book).
Discuss strategies for enabling pre-hospital providers to access
the online examination. If these providers cannot use your
hospital system to access the examination, course participants
can purchase the online examination as individual purchasers.

u Professional Silos
Less obvious and harder to address are the silos of healthcare
professionals how nurses, physicians, and respiratory
therapists are educated and socialized into their professions
differently and apart from their affiliated colleagues. Part of
the aim of improving healthcare through reform is to eliminate
the silos and capitalize on our common goals in patient care.
While ED staff may be able to access NRP courses if time and
cost can be justified, pre-hospital providers are less likely to
be welcomed as part of the neonatal resuscitation team in the
hospital setting.

Meet with the education leaders of the EMS units to assess their
needs for NRP Provider courses. Needs assessment is essential
to determine if pre-hospital providers should train with OB and
nursery staff or in other combinations to best meet newborn
care objectives. For example, NRP instructors and EMS staff
who work in rural areas may determine that it is most beneficial
to integrate their efforts with those rural hospital Emergency
Departments that have no delivery service but experience
drop-in births. In other areas, it may make sense to train
EMS staff along with hospital ED and neonatal/perinatal staff.
It may be most beneficial for healthcare professionals to train
as a team because an out-of-delivery-room birth may involve
a combination of healthcare teams who need to work together
during resuscitation.
Plan to include pre-hospital providers in every scheduled NRP
Provider Course.

Right care, right time, every time, regardless

of place should be a Neonatal Resuscitation
Program goal.

Whether the closed system of providing NRP to hospital staff

is based on convenience, cost, or unacknowledged professional
silos, we need to open our minds and our NRP courses to
pre-hospital providers. This is not operationally difficult and
promises to benefit infants born outside of hospital obstetric units.
Here are some tips for including pre-hospital providers in
hospital-based NRP Provider courses
V
 olunteer to give a Grand Rounds for pre-hospital providers
regarding neonatal resuscitation and how the Neonatal
Resuscitation Program works
Advocate for an interprofessional committee to help identify
educational needs of pre-hospital providers and coordinate
interprofessional Provider courses

VOL 21 NO 2 fall /w in t e r 2 0 1 2

If necessary, request budgetary support from pre-hospital

provider employers or charge a small fee.
Plan and implement mock delivery and resuscitation activities
in parking lots and ambulances, with pre- hospital providers
using their supplies and equipment. Include team members
who best meet the EMS staff learning objectives, including
neonatal and/or perinatal healthcare professionals and ED
staff if indicated.
Right care, right time, every time, regardless of place should
be a Neonatal Resuscitation Program goal. As NRP instructors,
we should address the barriers that prevent some pre-hospital
providers from accessing the education and training needed to
provide quality care to the compromised infant born outside the
delivery room. In this way, we help ensure that regardless of the
birth setting, every newborn receives quality care that influences
a lifetime.

Webra Price-Douglas, PhD, CRNP, IBCLC, Coordinator of the Maryland Regional

Neonatal Transport Program, contributed to this article.

Meeting NRP Provider Course Objectives:

May I Use the Integrated Skills Station for Simulation and Debriefing?

uestions from NRP Instructors about combining the

Integrated Skills Station (ISS) and Simulation/Debriefing
components of the Provider Course have been covered numerous
times in various formats, including a podcast available under the
Media Library tab on the NRP Website (www.aap.org/nrp) and
in the Spring/Summer 2012 issue of the NRP Instructor Update
(Combining the Integrated Skills Station and Simulation/Debriefing
Component, pg. 4).
NRP instructors have some flexibility in meeting the needs of
their learners. Individual Integrated Skills Station performances
may not be necessary for an experienced team of NRP learners.
If one instructor takes the same team of 3-4 learners through all
of the Performance Skills Stations and if that instructor facilitates
scenarios where each learner independently performs all relevant
skills beginning with Equipment Check and ending with either
Chest Compressions (Basic ISS) or the Medication Performance
Skills Station (Advanced ISS) each learner has accomplished
the objectives of the ISS. The instructor can then decide if there
is value in repeating individual ISS performances. Novice NRP
providers benefit from the repetition of individual Integrated
Skills Stations; expert NRP providers may be ready to proceed
to Simulation and Debriefing.
In this issue, we address this question from a different
viewpoint. An NRP instructor asks, I would like to film each
persons Integrated Skills Station Performance and evaluate
that performance for technical proficiency and NRP Flow
Diagram sequence. That takes care of the ISS. Then Id like
to use that film to debrief the communication and teamwork
aspects of the performance. This way weve already done
the scenario and debriefing, so we can skip the simulation
and debriefing component. Does this meet the objectives of
the NRP Provider Course?

This idea saves time, but learners would miss the opportunity
to practice teamwork and communication skills we expect
to see during an actual resuscitation. The ISS allows for little
teamwork, because the person being evaluated needs to direct
the interventions to demonstrate his/her understanding of the
cognitive and technical aspects of resuscitation. For the instructor
to assess the learners mastery of the NRP Flow Diagram and
technical skills, the instructor does not help the learner, and
assistant team members should not initiate interventions or coach
the person being evaluated during the ISS. It may help to tell the
learner being evaluated to consider the assistants as new graduate
nurses or first year residents who will need the learners direction
to initiate most of their actions.
In contrast, teamwork and communication skills are the focus of
Simulation and Debriefing. Scenario team members should talk
to one another, assist each other if necessary, and discuss their
next steps. The simulation and debriefing component focuses on
teamwork and communication, not technical skills.
When considering strategies to meet your NRP learners
objectives in an effective and high quality manner, consider
the purposes of the course components involved. In this case,
it would not be in the learners best interests to use the video of
an ISS performance to debrief participants about their teamwork
and communication skills.

It may help to tell the learner

being evaluated to consider the
assistants as new graduate nurses
or first year residents who will
need the learners direction to
initiate most of their action.

N R P I N STRUCTOR UPDATE

Whats New with the NRP Exam?

2013 NRP Research Grant

and Young Investigator Award
Call for Applications

The American Academy of Pediatrics

(AAP) Neonatal Resuscitation Program
(NRP) Steering Committee and the
Section on Perinatal Pediatrics are pleased
to announce the upcoming availability of the
2013 NRP Research Grant and Young Investigator
Awards. The awards are designed to support basic
science, clinical, or epidemiological research pertaining to the
broad area of neonatal resuscitation.

!
ing Soon
m
o
C

Physicians in training or individuals within four years of completing

fellowship training are eligible to apply for up to $15,000 through
the NRP Young Investigator Award. Any health care professional
with an interest in neonatal resuscitation can submit a proposal for
up to $50,000 through the NRP Research Grant Program.

I NS

RS

Grants are currently available to fund research projects in the

C T O and Canada. The NRP Steering Committee is
UStates
United
TR
particularly interested in the following research and pilot programs:

Effective delivery of ventilation

LI of oxygen
Use
C K H ERE
Chest compressions in the newborn
Optimization of NRP education

PR

For more details, please review:

Perlman J, Kattwinkel J, Wyllie J, Guinsburg R, Velaphi S.
Neonatal resuscitation: in pursuit of evidence gaps in knowledge.
Resuscitation. May 2012;83(5):545-550
IDER
O V Research
The NRP
Grant and Young Investigator Award Program
Guidelines and Intent for Application will be available in January
2013. To obtain a copy of the guidelines, a list of potential research
topics,
LI or a listRof previously funded studies, please contact the Life
C HE
SupportKstaff
at 800/433-9016 ext. 4798 or visit the NRP Web site
at www.aap.org/nrp and select the Science tab.

Since rolling out the new format in May 2011, HealthStream in

conjunction with the AAP have made some changes to the exam
delivery process to make it even easier to administer.

u Reports to Help you Track Licenses Learning Progress Report

This report shows how many licenses have been used by your
active students and the number of attempts made by each
individual. Administrators can run a full data extract and export
the data to Excel. Coming soon! This report will be modified to
run inactive student data as well.

u Managing Assignments
Remember that by default, the NRP exam is automatically reassigned
to students who fail. Prevent failed exams from being reassigned by
clearing the Automatically reassign course if student fails box when
creating the assignment.
If you need assistance with this step, please contact your
HealthStream representative. Please note: the box cannot be
cleared if assigned as part of a curriculum.
We encourage customers to develop their own NRP Exam policy
that defines how many times students will have to attempt to take
the exam before they are to stop and meet with their manager.
This limitation should be indicated early (and potentially often)
in the policy.

u All Lessons Required Version

While the AAP only requires that students pass lessons 1-4 and 9,
some facilities prefer that their clinicians pass all nine lessons. For this
reason we have launched a new version of the course that requires
that all lessons be completed. Both courses will be available to
administrators to assign to students based on the individual institutions
preference. Contact Customer Service if you would like the new
version published to your site: customer.service@healthstream.com.
NRP Online Examination, 6th Edition
(Original version, Lessons 1-4 and 9 required, 5-8 optional)
NRP Online Examination, 6th Edition (Lessons 1-9 required)

u Streamlined Administrator & Student Guides

We recently revised the NRP Guides so they contain only the
information you need to be successful with NRP. There are now
specific Admin & Student Guides for customers who access the
course using the HealthStream Learning Center (HLC), Content
Express & Content Connect to access the NRP Exam. We also
have a student user guide for the Individual Purchaser.
Coming Soon! Online training modules are being developed for
Administrators to complement the NRP Administrator Guides.

NRP Online Examination Reminder

As a reminder, all Hospital-based Instructors

and Regional Trainers are required to complete
the NRP online examination every 2 years,
beginning in 2013, based on their renewal
date. However, instructors do not need to
wait for their renewal date to approach to
take the online examination. The exam will
be provided at no charge to instructors once
per calendar year.

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u Community for NRP Administrators and Instructors

Visit the HealthStream Resuscitation Center!
Find valuable resources that will help you make the most of
your NRP Exam experience: Admin Guides & FAQs, Helpful
Tips & Tricks, Webinar Recordings, Customer Support Blogs,
& Discussion Forums with Best Practices.
The HealthStream Resuscitation Center requires a username
and password, the same that allow you to access HealthStream:
www.healthstream.com/NRP.