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Transitioning from NRP to a combined PALS-NRP resuscitation model at a level IV NICU

Journal of Perinatology volume 42, pages 1533–1534 (2022)Cite this article

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Neonates admitted to a level IV neonatal intensive care unit (NICU) frequently have complex medical conditions and require prolonged stays beyond 28 days of age. Given the acuity of medical problems and surgeries required, these neonates are at risk for cardiopulmonary events necessitating resuscitation. Two universally accepted programs address these issues—neonatal resuscitation program (NRP) which concentrates on delivery room resuscitation and pediatric advanced life support program (PALS) which focuses on a broader range of cardiopulmonary events [1, 2]. Over the past ten years, there have been several questions, discussions, and surveys evaluating the best form of resuscitation for neonates outside of the delivery room. In most NICUs, neonates receive NRP until they are discharged from the NICU [3]. In contrast, if a neonate is transferred to the PICU, they are likely to receive PALS, regardless of their age. Given the increasing population of older, chronic infants present in our level IV NICU, we sought to design and implement a new resuscitation guideline incorporating PALS and NRP for cardiopulmonary events at the University of Wisconsin and UW Health Kids American Family Children’s Hospital. Our study design did not address improvement in patient care or value of the intervention.

There have been 13,450 patient days since our PALS/NRP algorithm go-live. Fig. 1b displays the number of patient days by year divided by how many infants qualified for PALS or NRP based on our guideline. Overall, 28.9% of patient days have qualified for PALS versus 71.1% for NRP. During this time, there have been six documented codes (defined as requiring chest compressions), five of which qualified for NRP and one for PALS. The mean average gestational age at birth was 32 5/7 weeks while the mean corrected gestational age at the time of the code was 37 2/7 weeks. All of these were initially respiratory in origin and 5 of the 7 required either intubation, re-intubation, or a tracheostomy change. Only 3 of the 7 required epinephrine and 2 of the 7 were considered extensive lasting over 20 min and requiring boluses of calcium, saline and/or packed red blood cells. In addition to the codes, there were ten patients treated for arrhythmias (7 supraventricular tachycardia, 1 atrial flutter, 1 Wolf-Parkinson White, 1 ventricular tachycardia). Of these 10 patients, 4 had underlying cardiac disease and two with previous cardiac surgery. The majority were treated with medications though 2 patients required cardioversion.

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Fig. 1: PALS NRP Algorithm and Patient Days.

References

  1. American Academy of Pediatrics AHA. Pediatric advanced life support. 2016. American Heart Association. Dallas, TX.

  2. Weiner GM, Zaichkin J, Kattwinkel, J. American Academy of Pediatrics, American Heart Association. Textbook of neonatal resuscitation. 2016. American Academy of Pediatrics. Elk Grove Village, IL.

  3. Sawyer T, Clark A, Ridout R. Infant resuscitation outside the delivery room in neonatal-perinatal and pediatric critical care fellowship programs: NRP or PALS? Results of a national survey. J Neonatal Perinat Med. 2009;2:95–102.

    Article  Google Scholar 

  4. Panchangam C, Rodriguez C, Dyke Ii PC, Ohler A, Vachharajani A. A survey of academic neonatologists on neonatal electrical cardioversion and defibrillation. Am J Perinatol. 2021.

  5. Ali N, Sawyer T, Barry J, Grover T, Ades A. Resuscitation practices for infants in the NICU, PICU and CICU: results of a national survey. J Perinatol. 2017;37:172–6.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. University of Wisconsin, Department of Pediatrics, Division of Neonatology, Madison, WI, USA

    Matthew W. Harer & Jamie J. Limjoco

  2. UW Health Kids American Family Children’s Hospital, Madison, WI, USA

    Laura J. Konkol

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  1. Matthew W. Harer
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  2. Laura J. Konkol
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  3. Jamie J. Limjoco
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Contributions

MWH: significant contributions to the design and conception, data analysis and interpretation, drafting the manuscript, critical revision of the manuscript, and final approval. LJK: significant contributions to the design and conception, data analysis and interpretation, critical revision of the manuscript, and final approval. JJL: significant contributions to the design and conception, data analysis and interpretation, critical revision of the manuscript, and final approval.

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Correspondence to Matthew W. Harer.

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The authors have no financial disclosures. MWH is supported by the Wisconsin Partnership Program New Investigator Award and an institutional KL2 award (KL2TR002374).

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Patient consent was not required for this study.

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Harer, M.W., Konkol, L.J. & Limjoco, J.J. Transitioning from NRP to a combined PALS-NRP resuscitation model at a level IV NICU. J Perinatol 42, 1533–1534 (2022). https://doi.org/10.1038/s41372-022-01416-3

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