In twenty years, the Neonatal Resuscitation Program (NRP) underwent a fascinating evolution. The program germinated from a basic concept in the early 1980’s, to development of a superb educational program taught to over two-million health care professionals in more than 120 countries through award-winning state-of-the art interactive educational media. Throughout this evolutionary process, volunteers also established a voice for the unique needs of the newly born within the adult-oriented world of emergency cardiac care, which led to the development of an international consensus on science and evidence-based neonatal resuscitation guidelines. The Genesis, Adaptation, and Evolution of the NRP reviews the history of NRP and prospects for evolution in the next decade.
Pictured from left to right: Errol Alden, MD, Cathy Cropley, RN, MN, William Keenan, MD, Leon Chameides, MD, John Kattwinkel, MD, David Burchfield, MD, Ron Bloom, MD, John Raye, MD, and George Peckham, MD.
Ron Bloom, MD, FAAP
Catherine Cropley, RN, MSN
In the mid-1970s, with the emerging prominence of Neonatal Intensive Care Units, it became increasingly important that community hospitals recognize and provide initial management of infants requiring transfer to an NICU. At that time the National Institutes of Health (NIH) funded five projects to provide education regarding the fundamentals of neonatal care to Level I hospitals. The Drew Postgraduate Medical School in Los Angeles received one of these contracts, which resulted in the Neonatal Educational Program (NEP), a series of educational modules, slide tapes, and videotapes. Six modules from the NEP formed the basis of the Neonatal Resuscitation Program™.
Soon after the completion and dissemination of the NEP, the American Academy of Pediatrics assembled a group led by George Peckham, MD, FAAP, to address the adequacy of training for neonatal resuscitations. The group decided to utilize the modules in the Drew School NEP and requested that they be assembled in a way that would facilitate distribution on a national scale.
The basic principles underlying the design and development of the NEP were carried over wholly into the NRP. The goal was to develop a program that could be implemented in any hospital in the United States. It was designed to convey a minimum level of information in the absence of a knowledgeable instructor, but permit enhancement by an instructor with an in-depth understanding of neonatal resuscitation. It was also important to design the NRP so that the various levels of personnel working in the delivery rooms and nurseries throughout the country could complete the program at a level consistent with their responsibilities. Thus, the NRP recognized that while individuals involved with a resuscitation may have different levels of responsibility, the individual responsibilities merge together to become part of a whole.
Leadership for development of the NRP came from both the American Academy of Pediatrics (AAP) and the American Heart Association (AHA). During the initial phase of developing the NRP, Sandra O'Connell, then the Director of Emergency Cardiac Care Programs of the American Heart Association, and George Peckham, MD, FAAP, provided support for the project. At the time when a prototype for NRP was nearly complete, Errol Alden, MD, FAAP, joined the Academy as Director of Education. Dr. Alden worked to develop a collaborative relationship between the Academy and the AHA; this resulted in creation of a joint taskforce to review the material and lay the groundwork for the eventual dissemination of the program. Suggestions from the joint task force resulted in minor changes in content, mainly in the areas of medications, chest compression, and the management of meconium. However, the NRP retains much from the initial NIH-sponsored NEP project.
The instructional design and the dissemination of the NRP differed significantly from other AHA resuscitation programs. The self-instructional format of NRP, with frequent practice activities and reviews, permits flexible use with individuals or groups. Delivery of the major points is not dependent upon an experienced instructor; yet, the core curriculum can be enhanced by the clinical and educational expertise of the instructor. Other AHA-sponsored programs limited instructors to teaching only within the state in which they had been certified. Under the concept of perinatal regionalization, which was widespread in the early 1980s, the sphere of influence of a tertiary care center often reached across state lines. In recognition of this, instructor status permitted an individual to teach the course anywhere in the United States.
Implementation of the program began with the training of Regional Trainers (at that time, called National Faculty) in eight AAP Districts throughout the country. Members of the National Faculty were charged with the responsibility of training Regional Trainers as well as Hospital-Based Instructors throughout an AAP District. Thus, by using the regionalization system, dissemination of NRP moved from National Faculty at tertiary centers through Regional Trainers and Hospital-Based Instructors to Providers at all levels of perinatal services across the country.
Dr. Bloom was the primary investigator for the NIH grant that resulted in the development of the NRP and co-author of the original Textbook of Neonatal Resuscitation. Cathy Cropley co-authored the original Textbook of Neonatal Resuscitation with Dr. Bloom.