Which Resuscitation Guidelines Should Be Used For Neonates Beyond the Delivery Room?

Mary Puchalski, MS, RNC, APN/CNS


November 30, 2007


Is it necessary to train emergency department and pediatric department staff in the Neonatal Resuscitation Program in addition to Pediatric Advanced Life Support? How do these programs differ?

Response From Expert


Mary Puchalski, MS, RNC, APN/CNS
Adjunct Faculty, University of Illinois - Chicago College of Nursing; Clinical Nurse Specialist, Neonatal/Pediatrics, Elmhurst Memorial Hospital, Elmhurst, Illinois


The differences in content between these programs permit the practitioner whose primary practice setting is the delivery room to gain a more extensive understanding of the physiology of the newborn and hone the skills required for delivery room management. Practitioners who need to be able to care for children of all ages will learn the basic NRP protocols and practice strategies within the PALS program.

A primary difference between these 2 programs is the method of intravenous access that is emphasized. NRP recognizes that the newborn has an easily cannulated vessel available -- the umbilical vein (UV). This vessel, however, is only patent for the first day or two of life. The PALS training emphasizes the need to establish a means to administer systemic medications using either intravascular or interosseous access. Skills stations in each program are specific to the methods of vascular access included in the programs. The PALS program includes equipment and medication guidelines for infants who weigh at least 3 kg, about the size of a full-term newborn.

After the first 2 or 3 days of life, the ability to cannulate the umbilical vein of a neonate decreases dramatically. Hence, the PALS approach to implementing interosseous access becomes invaluable (except in the premature infant). There is no contraindication to attempting umbilical venous access if there is an individual skilled in this approach, but time should not be wasted trying to find someone skilled in umbilical cannulization when those who are already present are trained in interosseous access.

In summary, the NRP is specific to delivery room management of the newborn. The PALS program includes NRP recommendations for delivery room management and extends this learning to the special resuscitation needs of children of all ages. The program chosen for completion should be driven by the primary practice setting of the practitioner.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.