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8/12/2019 2013 FallWinter Iu
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VOL 22 NO 2 FALL/WINTER 2013
Suctioning theNewborn at Birth:Questionsand Answers
facebook.com/TheNRP
Instructor Update
I hear that the AAP/AHA Neonatal Resuscitation
Guidelines call for tracheal suctioning of the non-
vigorous meconium-stained newborn, but that the
procedure doesnt actually make any difference
to neonatal outcome. Why are we still doing this
procedure if it does not influence outcome or
prevent meconium aspiration syndrome?
The International Liaison Committee on Resuscitation
(ILCOR) still recommends tracheal suctioning for
the non-vigorous meconium-stained newborn. After
reviewing the evidence, the last ILCOR statement
regarding this was the following, which answers the
question above(from Kattwinkel et al. Circulation
2010; 122;S909-S919)
Although depressed infants born to mothers with
meconium-stained amniotic fluid (MSAF) are at
increased risk to develop MAS, tracheal suctioning
has not been associated with reduction in the
incidence of MAS or mortality in these infants.
The only evidence that direct tracheal suctioning
of meconium may be of value was based on a
comparison of suctioned babies with historic controls,
and there was an apparent selection bias in the group
of intubated babies included in those studies. In
the absence of randomized, controlled trials, thereis insufficient evidence to recommend a change
in the current practice of performing endotracheal
suctioning of nonvigorous babies with meconium-
stained amniotic fluid (Class IIb, LOE C). However, if
attempted intubation is prolonged and unsuccessful,
bag-mask ventilation should be considered,
particularly if there is persistent bradycardia.
To summarize, the available evidence was not strong
enough to support or refute the practice. The NRP
Steering Committee has been careful to not change
from one unfounded practice to another, but rather to
advocate for better evidence in order to inform futureguidelines. Because the review highlighted how little
evidence there was for meconium suctioning of non-
vigorous, meconium-stained newborns, there is now a
national call for an appropriate clinical trial to be done
to assess safety and efficacy of this long-standing
clinical practice. In the meantime, it seems prudent to
continue with our current practice.
ALTHOUGH DEPRESSED INFANTS BORN TO MOTHERS WITH MECONIUM-STAINED AMNIOTIC FLUID (MSAF) ARE
AT INCREASED RISK TO DEVELOP MAS,TRACHEAL SUCTIONING HAS NOT BEEN ASSOCIATED WITH REDUCTION
IN THE INCIDENCE OF MAS OR MORTALITY IN THESE INFANTS.
continued on page 5
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In This Issue
1 Suctioning the Newborn at Birth:
Questions and Answers
3 Improve Your Debriefing Skills
6 Preparing NRP Learners for Success:
The Online Examination
8 NRP Online Exam At-A-Glance
10 Tore Laerdal Becomes Honorary
Fellow of the AAP
12 Welcome and Farewell
12 NRP Research Grant Award
12 Reminder to Instructors to
Complete Exam
VOL 22 NO 2 FALL/WINTER 2013
NRPAcknowledgements
The Neonatal Resuscitation Program(NRP)
Steering Committee offers the NRP Instructor Update
to all AAP/AHA NRP Instructors.
Editor
Eric C. Eichenwald, MD, FAAP
Managing Editors
Rachel Poulin, MPH
Wendy Marie Simon, MA, CAE
Robyn Wheatley, MPH
Contributor
Jeanette Zaichkin, RN, MN, NNP-BC
NRP Steering Committee
Steven Ringer, MD, PhD, FAAP, Cochair
Brigham & Womens HospitalBoston, MA
Myra H. Wyckoff, MD, FAAP, Cochair
University of Texas Southwestern Medical Center
Dallas, TX
Anne Ades, MD, FAAP
The Childrens Hospital of Philadelphia
Philadelphia, PA
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
Stanford University
Palo Alto, CA
Marya Strand, MD, FAAP
Saint Louis University
St. Louis, MO
NRP Editors
John Kattwinkel, MD, FAAP
University of Virginia
Charlottesville, VAGary M. Weiner, MD, FAAP
Saint Joseph Mercy Hospital
Ann Arbor, MI
Jeanette Zaichkin, RN, MN, NNP-BC
Providence St. Peter Hospital
Olympia, WA
NRP Steering Committee Liaisons
John T. Gallagher, MPH, RRT-NPS
American Association for Respiratory Care
Rainbow Babies & Childrens HospitalCleveland, OH
Linda McCarney, MSN, RN, NNP-BC, EMT-P
National Association of Neonatal Nurses
The Childrens Hospital in Denver
Aurora, CO
Patrick McNamara, MB, FRCPC
Canadian Paediatric Society
The Hospital for Sick Children
Toronto, ON, Canada
Samuel Mujica Trenche, MD, FAAP
Section on Hospital Medicine
Las Vegas, NV
NRP Steering Committee Consultants
Louis P. Halamek, MD, FAAP
Stanford University
Palo Alto, CA
Jeffrey Perlman, MB, ChB, FAAP
ILCOR Science Director
Liaison AHA Pediatric Subcommittee
New York Presbyterian Hospital
New York, NY
Jerry Short, PhD
University of Virginia
Charlottesville, VA
AAP Staff Liaisons
Thaddeus Anderson
Kristy Crilly
Nancy Gardner
Jackie Hughes
Kirsten Nadler, MS
Rachel Poulin, MPH
Wendy Simon, MA, CAE
Robyn Wheatley, MPH
Statements and opinions expressed in
this publication are those of the authors
and are not necessarily those of the
American Academy of Pediatrics orAmerican Heart Association.
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, 2013
8/12/2019 2013 FallWinter Iu
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Improve Your Debriefing Skills
How can I prepare my learners for a
successful debriefing?
Prepare your learners ahead of time for what they
can expect during debriefing. Your provider course
should include a short orientation about how the
course is set up, including learner responsibilitiesfor participation. If participants are new to simulation
and debriefing, they should be told that debriefing
is when the instructor helps the learners talk to
each other about what went well and what could
have gone better during the scenario. As participants
gain experience with simulation and debriefing,
their skills at eliciting meaningful discussion from
their colleagues also improve. Debriefing is guided
by the instructor, but participants must engage
in the process.
What is the first question to ask at a debriefing?
Some instructors fear instructor freeze, which
occurs when an instructor faces the scenario
participants and cannot think of a single word
to begin the debriefing except, So
Avoid instructor freeze by remembering that your
first question should always establish the existence
of a shared mental model. Based on your information
about the infants gestation and risk factors, did
your learners see the newborns presentation as
you had planned? Ask, Tell me what you thought you
would need to do when the newborn first came
to the radiant warmer. Its a good idea to address this
first question to a less dominant member of the teambecause this person is unlikely to challenge a more
assertive team member who voices a different view of
the newborns initial status.
For example, imagine that your learning objectives
include tracheal suction for a non-vigorous meconium-
stained newborn. However, team members fail to ask
if the fluid was meconium-stained, and you do not
apply any substance to the newborn that resembles
meconium. The newborn was placed on the radiant
warmer where the team quickly proceeded through
initial steps and positive-pressure ventilation. Your
first question at the debriefing, addressed to a quieter
team member, is, Tell me what you thought you would
need to do when the newborn first came to the radiant
warmer. The reply, The newborn was limp, apneic,
and had a low heart rate so we proceeded with initial
steps. It is then clear to you that the team did not
anticipate or see meconium-stained fluid, and you did
not have a shared mental model of this scenario. You
may now conclude that the team did not necessarily
fail to intervene properly they simply missed the cues
they needed to manage a non-vigorous, meconium-
stained newborn at birth. You would correct this prior
to the next scenario by reminding team members to
ask the four questions prior to the birth to assess risk (if
the team does not recognize this during this debriefing)and you would apply a meconium-like substance to
the infant to provide an essential visual clue about the
newborns condition.
continued on page 4
NRP INSTRUCTOR UPDATE
NRPintroduced the simulation-based curriculum nearly two years ago. By now, most NRP instructors
have had an opportunity to conduct provider courses that include the required simulation and debriefing
component. Most instructors feel confident creating learning objectives and setting up scenarios;
however, many instructors ask the following questions about debriefing.
DEBRIEFING IS A FACILITATED INTERACTIVE
DISCUSSION ABOUT A PRIOR SERIES OF EVENTS.
THE INSTRUCTOR GUIDES THE DISCUSSION
WITH OPEN-ENDED QUESTIONS AND
ALLOWS REFLECTION AND SELF-DISCOVERY.
DEBRIEFING IS WHEN LEARNING OCCURS.
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VOL 22 NO 2 FALL/WINTER 2013
What other debriefing questions keep the discussion
moving forward?
Most provider courses have limited time for debriefing.After the shared mental model question described
above, the most important questions to ask include
the following:
What went well with your scenario?
What could have gone better?
What will you do differently next time?
Look at this list of NRP Key Behavioral Skills
and give an example of a skill you used (or
should have used to improve performance)
Do not allow team members to simply read off thelist of NRP Key Behavioral Skills, such as, I used
all available resources. The response requires
an example such as, When I paged anesthesia
to help with this difficult intubation, I used all
available resources.
Team members may not initially recognize their
behaviors as NRP Key Behavioral Skills. For example,
in response to your question about what went well,
a team member may state that she checked
equipment prior to the birth to make sure she had
everything needed, and she called an NNP to attend
the birth because of meconium-stained fluid. Thisteam member might need your help to recognize
these actions as Know Your Environment and Plan
and Anticipate. By naming the Behavioral Skills
team members may not even be aware that they use,
they can translate these skills into use when they
participate on teams that do not function well.
If the scenario is complex or if something unexpected
occurs such as a medication error or a breach of
professional behavior, it may be helpful to plan the
debriefing agenda with team members. Prior to asking
the shared mental model question, ask participants
to identify the issues they wish to discuss. List these
on a whiteboard or screen to help keep the discussion
focused on the issues at hand.
Stay alert for responses such as, I wish she would
have told me and I didnt know Or All I
needed was When these occur, this is your
opportunity to help improve team performance by
asking, How would that sound? or How could she
have told you or How could you have gotten the
help you needed?
Before your provider course adjourns, ask each
learner, What did you learn today? This helps
reinforce the concept that simulation and debriefing
is for learning, not for demonstrating perfect skills
and behaviors.
How can I get a quiet learner to speak up?
Begin a debriefing by asking a less dominant team
member the first question, which is the shared mentalmodel question, Tell me what you thought you would
need to do when the newborn first came to the radiant
warmer. Because there is no right or wrong answer
to this question, it may help put nervous learners
at ease. Quiet learners can also be brought into the
discussion by directing questions to them by name,
for example, Steve, how effective was the first try at
positive-pressure ventilation and how did the team
respond? Give the learner some time to formulate
an answer. Silence is not necessarily a bad thing.
The instructor who asks rapid-fire questions and
answers them without waiting for the teams response
soon has a silent and passive team who allows the
instructor to do all the talking. This is not beneficial
learning for anyone.
How can I strengthen my debriefing skills?
Review the NRP Instructor DVD.
Debrief everything. If you practice debriefing only
during NRP courses, it will take a long time to
become a skilled debriefer. Use debriefing skills
after every birth and after any event or procedure
that requires teamwork and communication.
Film yourself debriefing and view it after the course.Assess your skills by using the NRP Instructor
Simulation and Debriefing Checklist on page 140
of the Instructor Manual for Neonatal Resuscitation.
continued from page 3
Improve Your Debriefing Skills
LEARN MORE BY READING THE CHAPTERS ABOUT SIMULATION AND DEBRIEFING IN THE INSTRUCTOR
MANUAL FOR NEONATAL RESUSCITATION (2011).
8/12/2019 2013 FallWinter Iu
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continued from page 1
Suctioning the Newborn at Birth Q&A
What research is in progress on this topic? Is it
possible that the guideline for tracheal suctioning
will change with the next AAP/AHA guidelines?
It is possible, but it will depend on timing of when
studies are completed and the results of those studies.
What is the current advice about intubating and
suctioning the trachea twice when suctioning
meconium from the trachea?
If during tracheal suctioning there is return of
meconium, the provider may intubate a second time
as long as the heart rate allows. If the heart rate is
< 100 bpm then one attempt is all that should be
done, and then PPV should be initiated. If PPV does
not result in an increase in the heart rate, additionalsteps to improve ventilation should be initiated.
These include checking the mask seal, repositioning
the infant in the open airway position, suctioning
the mouth and nose again, opening the mouth,
increasing pressure and placement of an advanced
airway (MRSOPA). The best indicator that effective
ventilation is in progress is stabilization of the heart
rate above 100 bpm.
Can you explain why there is no difference in risk
between thin vs. thick meconium? I know this is old
information, but healthcare providers at our hospital
still consider thick meconium a more ominous sign
than thin meconium. Is there any way to predict the
neonatal risk based on the consistency of meconium?
The term thin versus thick is very subjective.
In addition, there is no data to support that
meconium consistency predicts risk or outcome.
If the amniotic fluid is meconium-stained and the
infant is vigorous, no matter what the consistency,
the infant should be treated like any other newborn.
If the amniotic fluid is meconium-stained and the
infant is non-vigorous, the medical provider should
attempt to clear the airway with tracheal suctioning
prior to stimulation, regardless of the consistency.The continued use of the terms in some hospitals
is likely a vestige of the out of date practice in
NRP editions 1 through 3 when the various
recommendations for meconium management
depended on the designation of thin versus thick.
These recommendations were not evidence-based,
but rather came from expert opinion. Starting in
2000, the NRP Steering Committee joined ILCOR
to review the available science for resuscitation
recommendations. At that time meconium
management strategies were changed from being
based on the consistency of the meconium to being
based merely on the presence of any meconium inaccordance with the best available evidence.
The current resuscitation guidelines discourage
the use of bulb suction for a newborn who has no
impedance to breathing. Does this also apply to
the OB provider who delivers the infant? Our OB
providers are not allowed to have a bulb suction
device on their instrument tray, although it seems
that a little suction might be a good idea for term
vigorous newborns who are breathing and crying,
but bubbling and gargling on secretions.
ACOG gives no specific guidance on this issue in the
circumstance of clear fluid. The authors of Williams
Obstetrics textbook suggest what the AAP/AHA
guidelines suggests, that routine suctioning of every
infant is not needed. Suctioning should be reserved
for those newborns who are unable to clear their
own airway (either apneic or choking on copious
secretions). Thus, it would seem prudent to allow the
OB provider to have access to a bulb syringe to use
with good clinical judgment about when to suction.
In the circumstance of a newborn born through
meconium-stained amniotic fluid, the current ACOG
statement (reaffirmed in 2013) mirrors what is said
in the AAP/AHA guidelines. There is no evidence tosupport routine intrapartum suctioning of meconium
by the OB provider. If meconium is present and the
newborn is depressed, the clinician should intubate
the trachea and suction meconium from beneath the
glottis. If the newborn is vigorous, there is no evidence
that tracheal suctioning is necessary.
NRP INSTRUCTOR UPDATE
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Healthcare professionals who are required to take an NRP
Provider course every two years can be unaware of courserequirements. Many errors are related to the NRP online exam.
NRP instructors report frustration with colleagues who:
Seem surprised to learn that the NRP online exam should have
been taken (and passed) prior to the course.
Take only Lessons 1-4 and 9 when their hospital requirement
is actually Lessons 1-9.
Wait until the night before the course to take the online exam,
fail it, and do not know how to access another exam before the
next day.
This type of miscommunication can be avoided. As an NRP
instructor, you can make essential course information, especiallyabout the online exam, accessible and easy to understand. If you
send NRP information as an email, make the subject line direct
and informative, such as NRP Course 2/14 at 0900: Pre-course
Requirements.
Put the most important information at the beginning of the
message. Create a standardized process for NRP participants and
keep it consistent to avoid confusion. Leave white space between
facts to facilitate comprehension for those who skim quickly for
information. Use bold print or color only for the most important
information. Avoid fancy backgrounds, distracting fonts, and
overuse of photos and diagrams.
The NRP instructor is responsible for making clear and concise
information easily accessible to course participants in a timely
manner. The course participant is equally responsible for
reading the information and following instructions.
Managing Failed Exams
It is important to communicate your institutions policy forhow to handle a failed online exam. For example, your course
information might include a bold-print sentence such as This
hospital covers the cost of the first NRP Exam attempt. If you
fail any lesson twice, you must begin the entire exam again.
You are responsible for the cost of another exam. Please call
___-___-____ if you need to purchase an exam from the course
coordinator or go to http://healthstream.com/hlc/aap
to create an account to purchase an exam with your credit card
as aSelf-Registration.
You may also set an internal policy that indicates that students
will reimburse the facility for additional exams after test failure.
Your HealthStream site allows you to run a Failed Coursereportto monitor failures and identify students who owe reimbursement
for secondary attempts. Alternatively, you can turn off the auto-
reassign feature and learners will not be able to enroll in the exam
subsequent times. They will need to contact their administrator
for the exam to be reassigned and at that point they can pay for
the exam if required.
Occasionally, a student will repeatedly fail the NRP online exam.
After several failed attempts, this student requires a remediation
plan. This plan may be individualized for each learner or may
be a standard plan developed by an institution. The learning
requirements of the plan are at the discretion of the instructor
and/or the institution. The plan should include additional time
for study and test practice using the review sections for self-
assessment and summaries of Key Pointsin each lesson. The
instructors role in the remediation plan is to assess potential
reasons for repeated failure. Many experienced neonatal
providers simply fail to study the textbook or accompanying
DVD-ROM prior to taking the exam. Others may rush through
the exam and misread questions and potential answers. When
reading comprehension is clearly the issue, it may be necessary
for the instructor to sit with the student during the exam and read
the questions and potential answers aloud. The instructor should
not coach or correct wrong answers for the student.
VOL 22 NO 2 FALL/WINTER 2013
Preparing NRPLearners for Success:The Online Examination
FOR MORE INFORMATION ABOUT THE NRP ONLINE
EXAMINATION AND SAMPLE LETTER TEMPLATES,
SEE CHAPTER 4OF THE INSTRUCTOR MANUAL FOR
NEONATAL RESUSCITATION (2011).
8/12/2019 2013 FallWinter Iu
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u You Have Registered for an NRP Provider Course
Date: Time:
Location:
(Insert link to directions if necessary.)
u Course Requirements:
Read the Textbook of NeonatalResuscitation, 6th editionor
view the textbook DVD-ROM.
Access a textbook and/or
DVD-ROM. (Insert instructions
specific to your institution.)
Pass the NRP online examination prior to the course,
but no sooner than 30 days before the course date.
See below for instructions about the online examination.
Bring your printed online examination verification from
the NRP online examination to the course.You will not
be admitted to the course without this document.
You Are Assigned:
qLessons 1-4 and Lesson 9
qLessons 1-9
qLessons 1-4, Lessons __, __, __, __, and Lesson 9
Demonstrate the above assigned neonatal resuscitation
lessons within the context of a clinical scenario in correct
sequence according to the NRP flow diagram, with
correct timing and proper technique. See textbook pages
299-302 as your guide.
Participate in simulation training and debriefing exercises
After you have attained NRP Provider status,
we recommend that you register with the
American Academy of Pediatrics for an online
reminder before your next renewal date:
www2.aap.org/nrp/provider_info-notify_service.html.
u Information About the NRP Online Examination
Access the NRP online exam by .
(Insert instructions here specific to your institution.)
If you fail any of the lesson exams twice, you will not be
able to continue the exam. The American Academy ofPediatrics deems that you must begin again with a new
examination. If you must begin anew, .
(Insert instructions specific to your institution.)
After exam completion, print your online examination
verification and bring this with you to the NRP course.
You will not be allowed to do the hands-on portion of
the course without this document.
You may start and stop the exam at your convenience, but
you must finish testing within 14 days of your original start
date. Most learners require about one hour when testing on
all nine lessons.
Take Lesson 9 last. If you take Lessons 1-4 and then take
Lesson 9, the application perceives that you have finished
the exam and locks you out of Lessons 5-8.
If you pass a lesson exam, you may print the questions you
missed. If you fail the lesson exam, you will not know which
questions you missed.
If you have questions, contact .
(Insert course contacts information here.)
Sample NRPProvider Course Information
NRP INSTRUCTOR UPDATE
AS AN NRP INSTRUCTOR, YOU CAN MAKE ESSENTIAL COURSE INFORMATION, ESPECIALLY ABOUT THE ONLINEEXAM, ACCESSIBLE AND EASY TO UNDERSTAND.
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NRPOnline Exam At-A-Glance
VOL 22 NO 2 FALL/WINTER 2013
Definitions
The HealthStream Learning CenterLMS, also known as the
HLC, is the most adopted learning management system in
the healthcare industry with more than 3.2 million healthcare
workers actively using our system. The HLC provides a robust
yet easy to use learning platform for scheduling, assigning,
tracking, delivering, and reporting on classroom and online
learning. The HLC supports more than 70,000 online course
completions and over 100,000 student log-ins every day, all
from users in a healthcare setting.
HealthStream Content Express (HEX)is an online LMS
for healthcare organizations who dont need all the features of
the HLC. HEX features access to online learning and student
self-registration. Content Express allows customers to assign
and manage specific HealthStream content without leverage
the full LMS functionality of the HLC. Consider this a very
basic version of the HLC.
HealthStream Connectis a custom integration that usesAICC protocols to pass progress and completion data for
online courses from HealthStream to a clients own LMS.
HealthStream has built Connect integrations with Learn.com,
SABA, SumTotal, Plateau and other leading LMSs so that
customers can continue to use their existing LMS to access
HealthStream content without switching to the full HLC.
For more information, visit
www.healthstream.com/products/learning-center.aspx.
Continuing Education Credit
The NRP online exam offers up to 9 CEUs. One credit hour
is awarded for each lesson successfully completed. To
obtain Continuing Education Credit, you must enter your
licensure information in your HealthStream record. To enter
this information click on the My Profiletab, click on Manage
Discipline and License Information, click on Add Discipline/
Licenseand enter your information. If you did not enter your
license information before completing the exam, you may add
this information later. To have the CE document you need
appear, click on My Transcript, click on Neonatal Resuscitation
Program Online Examination, 6th Edition, scroll to the bottom
of the page and click Refresh Credits.
Questions are commonly received regarding implementation of the
NRP Online Exam. As we are constantly innovating, what follows is
current information about the pricing structure for the exam, as well as
updated and complete information about continuing education credit
availability by discipline.NRPONLINE
EX
AMIN
ATIO
N
Clic
kHere
Pricing Grid Individual Purchase First 50 Exams/Yr. Next 51-250 Exams/Yr. Next 250+ Exams/Yr.
HealthStream/HLC Customer N/A $16.00 $12.80 $11.20
Non-HLC Customer N/A $20.00 $16.00 $14.00Individual Purchaser $23.50 N/A N/A N/A
Current NRP Instructor No Charge N/A N/A N/A
8/12/2019 2013 FallWinter Iu
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Medical Credits
Accrediting/Approval Body:
Accreditation Council for ContinuingMedical Education
Credit Units:9.00 AMA PRA Category 1 Credit(s)
Expiration Date:5/15/2014
Statement:The American Academyof Pediatrics is accredited by theAccreditation Council for ContinuingMedical Education to provide continuingmedical education for physicians.This activity was designated for 9.00AMA PRA Category 1 Credit(s).
This program is approved by theNational Association of PediatricNurse Practitioners (NAPNAP) for 9NAPNAP Contact Hours of which 0
are pharmacology (Rx) content. TheAAP is designated as Agency #17.Upon completion of the program, eachparticipant desiring NAPNAP contacthours should send a completedcertificate of attendance, along with therequired recording fee ($10 for NAPNAPmembers, $15 for nonmembers), to theNAPNAP National Office at 5 Hanover Sq.,Suite 1401, New York, NY 10004.
The American Academy of PhysicianAssistants accepts AMA PRA Category 1Credit(s)from organizations accreditedby the ACCME.
Disciplines: Emergency Physicians,Family and General Practitioners,Gastroenterologists, Obstetricians andGynecologists, Pathologists, Pediatricians,Physicians, Physicians Public HealthCertificate, Physicians Public PsychiatryCertificate, Physicians Area ClinicalNeed, Physicians Limited License,
Physicians Osteopathic, Podiatrists,Podiatrists Limited, Radiologists,Surgeons, Pedorthist, General Internists,Non-practicing Physician
States: AK, AL, AR, AS, AZ, CA, CO, CT,DC, DE, FL, GA, GU, HI, IA, ID, IL, IN, KS,KY, LA, MA, MD, ME, MI, MN, MO, MP,MS, MT, NC, ND, NE, NH, NJ, NM, NV,NY, OH, OK, OR, PA, PR, RI, SC, SD, TN,TX, UM, UT, VA, VI, VT, WA, WI, WV, WY
Nursing Credits
Accrediting/Approval Body:
American Nurses Credentialing Center
Credit Units: 9.00 Contact Hour(s)
Expiration Date: 3/7/2015
Statement: This continuing nursingeducation activity was approved by theOhio Nurses Association (OBN-001-91),an accredited approver by theAmerican Nurses Credentialing CentersCommission on Accreditation.
Program approved for 9 contact hours;approval valid through March 7, 2015.
Disciplines: Advanced PracticeRegistered Nurses, Anesthetists, CertifiedRegistered Nurse, Cardiovascular
Technologists and Technicians, Dietitiansand Nutritionists, Licensed PracticalNurses, Licensed Vocational Nurses,Medical Assistants, Midwives, CertifiedNurse, Nurse Practitioners, NursingAides, Registered Nurses, RegisteredNurses Advanced Registered NursePractitioner, Respiratory Therapists,Respiratory Therapists CertifiedRespiratory Care Therapist, RespiratoryTherapists Critical Care Practitioner,
Respiratory Therapists Non-critical CarePractitioner, Clinical Nurse Specialist,Prehospital Registered Nurse
States: AK, AL, AR, AS, AZ, CA, CO, CT,DC, DE, FL, GA, GU, HI, IA, ID, IL, IN, KS,
KY, LA, MA, MD, ME, MI, MN, MO, MP,MS, MT, NC, ND, NE, NH, NJ, NM, NV,NY, OH, OK, OR, PA, PR, RI, SC, SD, TN,TX, UM, UT, VA, VI, VT, WA, WI, WV, WY
Respiratory Therapy Credits
Accrediting/Approval Body:
American Association for Respiratory CareCredit Units:9.00 Contact Hour(s)
Expiration Date: 1/1/2014
Statement:This program has beenapproved for a maximum of 9 contacthours of Continuing Respiratory CareEducation (CRCE) credit by the AmericanAssociation for Respiratory Care, 9425N. MacArthur Blvd., Suite 100, Irving, TX75063, Course #128636000.
EMS Credits
Accrediting/Approval Body:
Continuing Education CoordinatingBoard for Emergency Medical Services
Credit Units: 9.00 Contact Hour(s)
Expiration Date: 1/31/2015
Statement: This continuing educationactivity is approved by the AmericanAcademy of Pediatrics, a CECBEMSaccredited organization.
You have participated in a continuingeducation program that has receivedCECBEMS approval for continuingeducation credit. If you have any
comments regarding the quality of thisprogram and/or your satisfaction with it,please contact CECBEMS at: CECBEMS,12200 Ford Rd., Suite 478, Dallas, TX75234, Phone: 972/247-4442,Email: lsibley@cecbems.org.
CECBEMS represents only thatits accredited programs have metCECBEMS standards for accreditation.These standards require soundeducational offerings determined bya review of its objectives, teachingplan, faculty, and program evaluation
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accreditation of the material.
NRP INSTRUCTOR UPDATE
FOR QUESTIONS ABOUT PRICING,
DELIVERY METHODS, OR TECHNICAL
QUESTIONS, CONTACT YOUR
HEALTHSTREAM REPRESENTATIVE
AT 800/521-0574, SELECTION
#6OR BY EMAIL AT
NRPONLINE@HEALTHSTREAM.COM.
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I f you have ever attended an AAP National Convention andExhibition or a major simulation technology conference,you may have run into Tore Laerdal at the Laerdal Medical
booth in the exhibition hall. Mr Laerdal enjoys chatting
with conference attendees and exchanging ideas aboutprofessional education and simulation science. You may not
have known that you were in the company of the Chairman
of Laerdal Medical, a Norwegian family-owned company
started by Asmund S. Laerdal in the 1940s and directed
by Tore Laerdal, his son, for more than 30 years.
The Laerdal Company in Stavanger, Norway began by
making childrens books and wooden toys in the 1940s.
The companys toy doll Anne was the first doll in Europe
made of soft PVC with natural stitched hair, soft unbreakable
parts, and sleeping eyes. At that time, no one could have
imagined where the Anne doll would lead the Laerdal
Company in its mission, which is Helping Save Lives.
When Tore Laerdal was 2 years old, his father saved him from
drowning. This experience, combined with new late 1950s
techniques in CPR, led the senior Mr Laerdal to develop
a life-size doll for training in mouth-to-mouth breathing.
Resusci Anne was the first in the Laerdal family of manikins
that have since been used to train several hundred million
people around the world in CPR techniques. Since the 1960s,
Laerdal Medical has been a leading supplier of training
materials and therapeutic equipment for acute medicine.
Tore Laerdals contributions to simulation technology,
patient safety, and global efforts to save lives of mothersand newborns in the developing world are too numerous
to mention in this limited space. Here are highlights of
Mr Laerdals most outstanding accomplishments.
Since the late 1990s and 2000s, Mr Laerdals focus shifted
from defibrillator access and technology to education of
healthcare providers through patient simulation. Laerdal
Medical has introduced developments in both hardware
and software that have changed educational methodologies.
He is responsible for the shift in the simulator industry
to include appropriate human models for neonatal and
pediatric populations. Through partnership with the AAP, he
is responsible for development of SimNewB, SimJunior,
SimplyNRP, and the new MicroSimulation platform.
Recognizing that learning technologies are effective only
when integrated within delivery of validated educational
programs, Mr Laerdal has fostered partnerships with the
American Heart Association and the National League
for Nursing. He also provided educational curriculum
to support nursing, medicine, EMS, military, and
voluntary organizations.
In the past 20 years, the Laerdal Foundation has provided
funding to nearly 2,000 projects to advance resuscitation
science, educational science, and good will initiatives.
In 2007, Mr Laerdal was influenced by the NRP Steering
Committees vision of a neonatal resuscitation curriculum
for low resource settings. The Laerdal Foundation provided
the AAP with $600,000 in startup funds, along with the
services of an educational designer and medical illustrator,
to develop materials that would become Helping Babies
Breathe (HBB) www.helpingbabiesbreathe.org.
Tore Laerdal Becomes HonoraryFellow of the AAP
VOL 22 NO 2 FALL/WINTER 2013
In October 2013, Mr Tore Laerdal, Chairman of Laerdal Medical,
was made an honorary Fellow of the American Academy of Pediatrics.This honor has been awarded to only a few non-pediatricians who
have demonstrated tremendous commitment to children and whose
heroic efforts have helped further the AAP mission.
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Mr Laerdal spearheaded a team of engineers to develop an
affordable and portable neonatal simulator to complementHBB (The NeoNatalie Newborn Simulator). NeoNatalie
includes 3 squeeze bulbs to simulate crying, breathing,
and umbilical pulse. It is now available on a not-for-profit
basis to Millennium Development Goal countries through
Laerdal Global Health.
Concerned with risk of infection due to reuse and poor
cleaning of suction devices in low resource settings,
Mr Laerdal worked with engineers to develop a suction
unit known as the NeoNatalie Penguin suction device
(www.laerdal.com/us/doc/2244/Penguin-Suction-Device)
which is made in one piece of silicone that can be boiled or
autoclaved and withstands hundreds of uses. This devicewas recognized by the World Health Organization as one of
20 breakthrough innovative technologies to help advance
the United Nations Millennium Development Goals (MDG)
to reduce child and maternal mortality. Read about the
MDG 4 and 5 at www.unmillenniumproject.org/goals/gti.htm.
Mr Laerdals commitment to HBB led to the signing of
the landmark HBB Global Development Alliance (GDA)
between USAID, AAP, NICHD, Save the Children, and
Laerdal Medical. The tremendous scale up efforts and
momentum within 18 months by GDA partners were
recognized in 2011 as GDA of the Year. Three years after
the GDA launch in 2010, Helping Babies Breathe has
been introduced in more than 60 countries and aims at
training 1 million birth attendants by the end of 2015. Close
to 50,000 NeoNatalie simulators and 150,000 Penguin
suction devices are now in use in low resource settings.
At the launch of the Saving Lives at Birth initiative,
Secretary of State Hillary Clinton stated that the U.S.
Government had partnered with Laerdal to develop
breakthrough innovation in newborn resuscitation.
As part of HBB scale up efforts in Tanzania, Mr Laerdal
provided country-level support to coordinate a 2-year
outcomes study. The results, published in Pediatricsin
February 2013, define the success of the collaborationbetween the AAP and Laerdal. After introduction of HBB,
the percentage of fresh-stillborns decreased by 24% and
infant mortality in the first 24 hours of life decreased by
an astounding 47%.
Mr Laerdal, concerned about maternal postpartum
hemorrhage, developed the MamaNatalie simulator totrain birth attendants about intrapartum care, postpartum
hemorrhage, and effective communication. MamaNatalie
received a 2011 EMS World Innovation Award. Read more
at www.emsworld.com/article/10445661/2011-ems-world-
innovation-awards?page=5.
The Laerdal Foundation funded the development of
Helping Mothers Survive (HMS), currently being piloted
by Jhpiego, an international, non-profit health organization
affiliated with The Johns Hopkins University that develops
strategies to help countries care for themselves by training
competent health care workers, strengthening health
systems, and improving delivery of care. www.jhpiego.orgThe Laerdal Foundation has earmarked $10 million
for United Nations MDG 4 and 5 projects over the
next 5 years. Read more at www.laerdalfoundation.org/
developing_countries.html.
In September 2013, Laerdal Global Health received the
Index Award (BODY Category) for its Natalie Collection
(NeoNatalie, Penguin Suction device, and MamaNatalie
contained in a backpack). The Index Awards are
recognized as the most important design awards in the
world, for designing sustainable solutions for global
challenges. Laerdal donated the large cash prize to the
International Confederation of Midwives (ICM) to supportdistribution of Helping Mothers Survive and Helping Babies
Breathe among its members in developing countries. Read
more about the Index Awards at www.designtoimprovelife.
dk/trio-of-life-saving-devices-reduce-childbirth-mortality.
Tore Laerdal is a worthy recipient of the honorary AAP
Fellow title. The American Academy of Pediatrics is
privileged and fortunate to have such a friend and
advocate in Mr Tore Laerdal.
NRP INSTRUCTOR UPDATE
IN THE PAST 20YEARS, THE LAERDAL FOUNDATION HAS DONATED OVER $120MILLION TO ADVANCE
RESUSCITATION SCIENCE, EDUCATIONAL SCIENCE, AND GOOD WILL INITIATIVES.
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Welcome and Farewell
The NRP Steering Committee is in the
midst of a very exciting transition as it plans
and develops the next generation of NRP
materials. In July, the transition continued
as the committee welcomed a new cochair
and general member and celebrated theachievements of those who rotated off the
committee. The NRP and AAP welcome these
new members and applaud those leaving for
their efforts, commitment, and dedication.
Over the years, Jane E. McGowan, MD, FAAP has watched many
people come and go from the NRP Steering Committee. In July, it was
her turn to step aside as her tenure came to end after serving 10 years
on the committee, first as a member and then for the last four years
as a committee cochair.
During the 10 years I spent as a member of the NRP Steering
Committee, I had the privilege of working with many very talented
individuals who were truly dedicated to improving outcomes for
newborns throughout the world. As a group, we have embraced
innovative educational methodologies and, more importantly, have
never been afraid to change the paradigm if we thought it would be best
for the babies. I know of no other long-standing committees that were as
willing as the members of the NRPSC to make major program changes
when deemed necessary. I will always be grateful to Dr. David Boyle
for inviting me to join the committee, and am honored to have been
able to contribute to the committees progress. I hope to continue my
participation in NRP activities throughout my career.
Taking the cochair reins from Dr McGowan is Steven Ringer, MD, PhD,
FAAP. Dr Ringer, Assistant Professor of Pediatrics at Harvard Medical
School and editor of the NRP Online Examination is making the transition
from committee member to cochair. He is overseeing the ongoing
revisions for the NRP Online Examination and actively involved in theNRP Strategic Plan to further science and research.
It is a great honor to serve with Myra Wyckoff, MD, FAAP as cochair of
NRP Steering Committee! Beyond our responsibility to the babies, I am
proud of the committees deep sense of responsibility to the instructors
who work hard to ensure that the principles and evidence behind NRP
are brought to the learners. I look forward to continuing the long tradition
of ensuring that NRP Steering Committee members are available and
responsive to your needs and ideas, said Dr Ringer.
Marya Strand, MD, MS, FAAP joined the Committee to fill the general
member vacancy left by Dr Ringer. Dr Strand is an Associate Professor
of Clinical Pediatrics at Saint Louis University. She also serves as the
Director of the Simulation-based Medical Education Program at Saint Louis
University. Dr Strand is very excited to join the NRP Steering Committee,
I have had an opportunity to work with some of the members through
the International Liaison Committee on Resuscitation (ILCOR) Neonatal
Task Force and admire the dedicated work that the Steering Committee
does. My clinical interests are in neonatal resuscitation as well as
educational methods for teaching residents, fellows and resuscitation
teams, so the NRP Steering Committee is a great fit with my interests. I
hope to contribute to the work of the Committee and help continue the
great progress in education that NRP is providing to medical providers.
NRPOnline Examination ReminderAs a reminder, all Hospital-based Instructors and Regional Trainers are
required to complete the NRP online examination every 2 years, based
on their renewal date. However, instructors do not need to wait until
just before their renewal date to take the online examination. The exam
will be provided at no charge to instructors once per calendar year.NRP instructors can take the online examination at any time during
their 2 year instructor status period by going to the NRP homepage
www2.aap.org/nrp and clicking on NRP Online Exam and following
the instructions for NRP instructors. Not sure if youve already taken
the Online Examination during your 2 year instructor period? Go to
the NRP homepage, click on NRP Course Database and enter your
ID and password. Then click on Update Information to see the
expiration date of your NRP Instructor period and the date of the last
time your passed the NRP Online Examination.
VOL 22 NO 2 FALL/WINTER 2013
2014 NRPResearch Grant
and Young Investigator
Award Call for Applications
The America Academy of Pediatrics (AAP)Neonatal Resuscitation Program (NRP)
Steering Committee is pleased to announce
the upcoming availability of the 2014 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.
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.
Grants are currently available to fund research projects in the
United States and Canada. The NRP Steering Committee is
particularly interested in the following research and pilot programs:
Effective delivery of ventilation
Use of oxygen
Chest compressions in the newborn
Optimization of NRP education
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
The NRP Research Grant and Young Investigator Award Program
Guidelines and Intent for Application will be available in January 2014.
To obtain a copy of the guidelines, a list of potential research topics,
or a list of previously funded studies, please visit the NRP website at
www.aap.org/nrp and select the Science tab.
ComingSoon!
Steven Ringer, MD, PhD, FAAP
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