Neonatal Resuscitation Program and Pediatric Advanced Life Support.

The need for delivery resuscitation of the newborn cannot be predicted in most cases; therefore it is judicious to train all providers who may be involved in the delivery of newborns to follow guidelines developed to improve outcome, especially in the presence of transitional asphyxia. The Neonatal Resuscitation Program emphasizes basic steps of warming, drying, suctioning, and adequately ventilating the newborn. It also addresses current theories regarding resuscitation of the low birthweight newborns, infants with meconium aspiration, and medication use. The NRP applies to all acute-care hospitals that provide delivery services and those at which a respiratory therapist is likely to be present in the high-risk delivery or unanticipated delivery-room resuscitation. Outcomes have not been well documented and more clinical research is needed to identify which therapeutic strategies promote the best survival in this population. A topic that should be included in the NRP of the future is exogenous surfactant delivery. Respiratory distress syndrome has been a significant cause of death and morbidity in prematurely born neonates. Exogenous surfactant therapy has had a dramatic effect on the death rate of premature infants and on the incidence of respiratory distress syndrome. Current methods of surfactant administration demand that personnel proficient in management of the low birthweight newborn be present. As hospitals with all levels of nurseries continue to receive the prematurely delivered newborn and better methods to administer surfactant are discovered, the NRP could add information and a skills laboratory on surfactant administration. A trained cadre of health professionals who are proficient in the specific resuscitation skills required in pediatric patients can make a difference. The infant and child have different anatomy, physiology, and disease etiology that need to be emphasized and understood by the pediatric caregiver. The Pediatric Advanced Life Support course focuses on early recognition and treatment of respiratory failure and shock. The possibility of improving outcome with properly trained prehospital providers is a topic of interest. Intubation in the field can be successful and may contribute to a reduction in mortality, although complications of field intubation need to be reduced.