Infant resuscitation outside the delivery room in neonatal-perinatal and pediatric critical care fellowship programs: NRP or PALS? Results of a national survey

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.