Infant resuscitation outside the delivery room in
neonatal-perinatal and pediatric critical care fellowship programs: NRP or
PALS? Results of a national survey
Affiliations: Department of Pediatrics, Tripler Army Medical Center,
Honolulu, HI, USA
Note: [] Corresponding author: Taylor Sawyer, DO, Department of
Pediatrics, MCHK-PE, 1 Jarrett White Road, Tripler Army Medical Center,
Honolulu, HI 96859-5000, USA. Tel.: +1 808 551 9074; Fax: +1 808 433 6046;
E-mail: [email protected]
Abstract: Introduction: Infant cardiopulmonary resuscitation outside the
delivery room can follow one of two national guidelines: Neonatal Resuscitation
Program (NRP), or Pediatric Advanced Life Support (PALS). Important differences
exist between NRP and PALS guidelines. There are no published recommendations
concerning the chronologic age at which to change from NRP to PALS guidelines.
This study was designed to investigate current resuscitative practices outside
the delivery room for infants cared for in Neonatal-Perinatal (N-P) and
Pediatric Critical Care (PCC) medicine fellowship programs with regard to the
use of NRP or PALS guidelines. Methods: Surveys were mailed to the program director of all
one hundred fifty-eight ACGME accredited N-P and PCC medicine fellowship
programs in the US. The survey included questions regarding the existence of
written resuscitative policies for infants regarding the use of PALS versus
NRP, provider certification requirements in NRP and PALS, resuscitation
leadership, and the age after birth at which infants are resuscitated using
PALS rather than NRP guidelines. Results: Of the 158 programs surveyed, 98 responded (62%).
Of those responding only one center (1%) reported having a written policy
concerning the use of NRP versus PALS. Significant differences were seen in
provider certification requirements in NRP and PALS. There were significant
differences in the time to change from NRP to PALS guidelines between
responding N-P programs and PCC fellowship programs. None of the responding PCC
programs reported using NRP guidelines past two months of age, while 35% of
N-P programs continued to resuscitate infants using NRP guidelines up to 1 year
of life. Twenty seven percent of responding N-P programs reported using "NRP
only" for infant resuscitation. Conclusions: We found no consensus regarding the age at which
infants are resuscitated with PALS rather than NRP in responding N-P and PCC
fellowship programs. Our findings suggest that compared to infants cared for
under the supervision of physicians in PCC medicine fellowship programs,
infants cared for under the supervision of physicians in N-P medicine
fellowship programs are much more likely to be resuscitated using NRP
guidelines. While it is unclear if this variation in clinical practice has a
significant effect on outcomes, this variation in practice makes it difficult
to define the current standard of care for infant resuscitation in N-P and PCC
fellowship programs and requires further investigation.
