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jminski

NRP vs PALS for neonatal patients

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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.

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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

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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.

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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.

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The PALS vs NRP controversy continues but broadens.

1. When do you transfer an infant in the NICU to the PICU?

2. If the infant stays in your NICU,, at what age do you switch to PALS?  3 months? 6 months? 9 months?

3. Should Neonatologists have to learn both PALS and NRP?

5. ILCOR should put out a statement to stop confusion.

 

 

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12 hours ago, mkaneta said:

The PALS vs NRP controversy continues but broadens.

1. When do you transfer an infant in the NICU to the PICU?

2. If the infant stays in your NICU,, at what age do you switch to PALS?  3 months? 6 months? 9 months?

3. Should Neonatologists have to learn both PALS and NRP?

5. ILCOR should put out a statement to stop confusion.

 

 

This is one of my favorite topics but one which I have no academic time to pursue.  

1) I think this has little to do with science and everything to do with the relative strengths, weakness and, frankly, interests of the NICU and PICU staff.  Our NNPs are only credentialed to provide care upto 1 year of age, so a lot of the thinking at our institution is based around this.  Also, I don't think it makes a lot of sense to send kids to PICU before they are term corrected unless there are VERY good institutional reasons.

2) At my out born unit the default from nursing and RT, etc. is always NRP so we've developed systems that focus on getting everyone onto PALS if that is deemed more appropriate.  For certain cardiology patients who are in the NICU and not the CICU this becomes part of bedside hand off and the stated plan each day as well as signs at bedside (though I don't think we are very good at always doing the sign).  For bigger/older kids, the code leader also always announces the algorithm they intend to follow and when they are changing algorithms and a charge RN will ask if an algorithm isn't stated in the first 30-60 seconds of arrival at a code.  We've developed this culture because our group's consensus (if you can call it that) is that we should use the algorithm that makes sense for the reason for the code and these cannot always be anticipated.

3) We're all (residents, fellows, attending, APN) trained in both PALS and NRP

5) Agree that ILCOR should make a statement, but I'm not sure there is evidence to recommend anything other than 'use common sense' and 'more study needed' 

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