New neonatal resuscitation practice recommended by NRP

A new study published in the AAP News and Journals Gateway reports that the Neonatal Resuscitation Program (NRP) is associated with an increased incidence of neonatal intensive care unit (NICU) admissions for respiratory issues but not linked to an increased incidence of meconium aspiration syndrome.

The NRP recommended against routine endotracheal suctioning of meconium-stained non-vigorous newborns but suggested resuscitation with positive pressure ventilation.

The Neonatal Resuscitation Program is an educational program in neonatal resuscitation that was developed and is maintained by the American Academy of Pediatrics. This program focuses on basic resuscitation skills for newly born infants.

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Arpitha Chiruvolu and associates conducted a multicentered cohort study to analyze the effects of this change in management.

The investigators compared 130 non-vigorous newborns born during the retrospective 1-year period before the implementation of new NRP guidelines (October 1, 2015, to September 30, 2016) to 101 infants born during the 1-year prospective period after implementation (October 1, 2016, to September 30, 2017).

The key study findings included are:

• Endotracheal suctioning was performed predominantly in the retrospective group compared with the prospective group (70% vs 2%), indicating the change in practice.


• A significantly higher proportion of newborns were admitted to the NICU for respiratory issues in the prospective group compared with the retrospective group (40% vs 22%) with an odds ratio (OR) of 2.2.


• Similarly, a significantly higher proportion of infants needed oxygen therapy (37% vs 19%) with an OR of 2.5, mechanical ventilation (19% vs 9%) with an OR of 2.6, and surfactant therapy (10% vs 2%) with an OR of 5.8.


• There were no differences in the incidence of other outcomes, including meconium aspiration syndrome.

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The study concluded that the recent NRP guideline change was not associated with an increased incidence of meconium aspiration syndrome but was associated with an increased incidence of NICU admissions for respiratory issues. Moreover, the need for mechanical ventilation, oxygen, and surfactant therapy increased.

Meconium aspiration syndrome (MAS) also known as neonatal aspiration of meconium is a medical condition affecting newborn infants. It describes the spectrum of disorders and pathophysiology of newborns born in meconium-stained amniotic fluid (MSAF) and has meconium within their lungs