NRP vs PALS for neonatal patients

[jminski]

I would like for others to comment on this question. For infants older than lets say 3 days old if they are to arrest in the nicu which sequence for cpr would be most approriate. The nrp 3:1 ratio or pals 15:2 (2 person)? When does nrp guidlines stop and pals begin? For our most complicated babies who may be in nicu for months this can be an issue. It is also an issue for training of staff who work in this area and it can be very confussing for those staff who work wards/picu and nicu? Please comment.

[sarvi]

I had recently attended a PICU study day and this topic was brought forward for discussion. There was mixed opinion amongst the participants. The neonatalogists were for 3:1 ratio for all neonates and Paediatricians were for 15:2 for all children (including neonates). The PICU team where I work, use 15: 2 for all children.
The APLS guidelines in UK donot distinguish it very clearly. In the APLS Manual, the recommendation is to use 15:2 for all infants (<1 year) but it is not clear what to do to for a week old infant admiited to Paediatric ward. I would personally do a CPR with 15:2 ratio for all children beyond the initial neonatal resuscitation

[Lama]

I happen to be an NRP regional instructor and I asked this very specific question to the NRP officials via email. The response I received, which for me makes sense, is there should be a policy in each hospital on which guidelines to use and where depending on the setup of the hospital, the staff education and their comfort level doing resuscitation using NRP or PALS recommendations. Bottom line, outside the delivery, and until new eveidence, you do the best you can with the method you feel you are most skilled.

[enaid1]

My quick response to your question...an infant is classified as a neonate from birth until 4weeks of life. If a 3 day old infant would require resuscitation the NRP 3:1 ration would be appropriate. As an NRP instructor I also agree with Lama's "bottom line" comment.