The Neonatal Cardiopulmonary Resuscitation (NCPR)2020

Skill Training Course
Self-Check Sheet
NAME

１

Brieﬁng

Supplemental oxygen

NCPR2020 Algorithm

Thermal management

Proper use

Appropriate equipment

Team briefing,
PPE, and Equipment check

Operation check

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth

Information sharing

Role assignment p1

２・Preterm?
・Weak respiration?
・Weak tone?

Assessment
immediately
after birthp2

Weak tone?

Within60 seconds(Consider SpO2
monitoring)

Heart rate assessment
Pulse oximeter,
probe location

・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

Other methods

Positive pressure
ventilation (PPV)HR・Check ventilation (b)・Consider intubation

HR<60/min.

IC clamp
Pressure・ Search for the cause
and…
・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.

Oxygen concentration

Consider IV adrenaline

Chest movements
ECG monitors

HR

Corrective ventilation
steps

Cyanosis

Post
Resuscitation
care
・Carefulobservation
on respiration

8

CPAP・Pressure・Oxygen concentration
Free-ﬂow oxygen

p14.15(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.

9(c) PPV 30/min. and chest compression 90/min

6

Location
Techniques
Coordination with PPVOxygen concentration

p8.9

Medications(Adrenaline/Epinephrine)
Dose

Laryngeal mask

Right drug?

p16.17
7

Other medications
Dose
Route

Route

10 Resuscitation ofpreterm infants
Body temperature

Right drug?

p10.11Intubation/ LM
Endotracheal intubation

Rate
Depth

CPAP/O2(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.

PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPVChest compressions

・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.
HR<60/min.

p4〜7

NO

Labored breathing
・Grunting・Retractions
・Tachypnea
・Nasal ﬂaring

Not
ImprovingHR≥ 60/min.

HR

Rate

５

ImprovingLabored breathing or
cyanosis (low SpO2)

Tactile stimulation
・Part ・Method p3

Labored breathing/
Cyanosis assessment

YES

PPV(+O2) + Chest compression (1:3) (c)Mask sizeNO・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR≥100/min.

Providing warmth

Suctioning(Airway opening)・Pressure ・Tube size

cyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

Auscultation

４

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR

Initial steps ofresuscitation

Positioning
・Sniﬃng position
・Shoulder rollRoutine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES

Weak respiration?

3

Dry

NO

Warm,
open airway (positioning, etc.),
dry, and stimulate

Preterm?

SpO2 (%)
≥60
≥70
≥80
≥90

p12.13

Cord milking
Delayed cord clamping
PEEP
CPAP

Committee on Neonatal Resuscitation
Japan Society of Perinatal and Neonatal Medicine

p18

1 Brieﬁng
NAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

YES
・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊

Conﬁrm necessary equipment for resuscitation.

Conﬁrm and understand the roles of resuscitation team members.

1・Carefulobservation
on respiration(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.
(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.
(c) PPV 30/min. and chest compression 90/min

Pre-training
check.

Understand the importance of brieﬁng with team members before resuscitation.

Discuss necessary measures to prevent infection.

Skill

Post
Resuscitation
care

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Check for critical knowledge and performance

Knowledge

・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HRNO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

2 Assessment immediately after birth
NAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

YES
・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HR(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.

(c) PPV 30/min. and chest compression 90/min

Pre-training
check.

→(1) Preterm, (2) Weak breathing/Crying, (3) Weak muscle tone

Knowledge
Understand when initial steps for resuscitation are required.
→Perform the initial steps of resuscitation if any one of the three evaluation points is met.

Check gestational age (preterm or term).

Check muscle tone.

2・Carefulobservation
on respiration(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.

Understand three evaluation points to be made immediately after birth.

Check respiration or crying.

Post
Resuscitation
care

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Check for critical knowledge and performance

Skill

NO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

3 Initial steps of resuscitationNAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)

YES・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HR

Preparation(c) PPV 30/min. and chest compression 90/min

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Pre-training
check.

For term infants with clear amniotic ﬂuid: 10Fr or 8Fr.
For low birth weight infants with clear amniotic ﬂuid: 8Fr or 6Fr.
For term infants with meconium-stained amniotic ﬂuid: 12Fr or 14Fr.

Wipe airway amniotic ﬂuid with a pre-warmed dry towel.
Remove wet towel.

Positioning.

Keep sniﬃng position with shoulder roll.
Avoid deep insertion of suction catheter.

Skill
Open-airway
management.

Keep suction time within 5 seconds.
Understand the order of suction.
→Suction the oral cavity ﬁrst and then the nasal cavity.
Use the negative pressure within 100 mmHg (13 kPa).

Tactile stimulation.

Rub the neonate s back, trunk, or limbs with warmed towel gently.
Tap or ﬂick the soles of the neonate s feet brieﬂy.

3・Carefulobservation
on respiration(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.

Bring to radiant warmer.
Warmth and dry.

Post
Resuscitation
care(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.

Check for critical knowledge and performance
Selectappropriate size ofsuction catheter.

NO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

4 -1 Ventilation (self-inﬂating bag)NAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

YES
・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HR(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.

(c) PPV 30/min. and chest compression 90/min

Pre-training
check.

→Recognize apnea or bradycardia of less than 100/min after initial steps of resuscitation.

Understand that eﬀective ventilation should be initiated by 60 seconds of lifeat the latest if the child does not respond to the initial steps of resuscitation.
Understand the oxygen concentration to use when initiating ventilation in term neonates.
→21％（room air）
Select the bag for neonate.
Check the bag before use (pressure release valve, break of the bag etc.)
Understand criteria to select the mask size.
→Select appropriate mask size (cover the neonate s nose and mouth but not the eyes.)
Keep sniﬃng position with shoulder roll (assess the open airway).
Hold the neonate s jaw and the mask with the IC clamp technique.

Skill

Put the mask on the neonate s face and keep airtight seal.
Provide ventilation at a rate of 40 to 60 breaths per minutes.
Check chest movements.

4・Carefulobservation
on respiration(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.

Understand the indications for ventilation.

Preparation

Post
Resuscitation
care

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Check for critical knowledge and performance

Knowledge

NO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

4 -2 Ventilation (ﬂow-inﬂating bag)NAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

YES
・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HR(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.

(c) PPV 30/min. and chest compression 90/min

Pre-training
check.

Understand that eﬀective ventilation should be initiated by 60 seconds of lifeat the latest if the child does not respond to the initial steps of resuscitation.
Understand the oxygen concentration to use when initiating ventilation in term neonates.
→21％（room air）
Attach a manometer (pressure gauge).
Set ﬂow rate to approximately 5 to 10 mL/min.
Understand criteria to select the mask size.
→Select appropriate mask size. (Cover the neonate s nose and mouth but not the eyes.)
Keep sniﬃng position with shoulder roll (assess the open airway).
Hold the neonate s jaw and the mask with the IC clamp technique.

Skill

Put the mask on the neonate s face and keep airtight seal.
Initiating ventilation with pressure to 20 to 30 cmH2O.
Provide ventilation at a rate of 40 to 60 breaths per minutes.
Check chest movements.

5・Carefulobservation
on respiration(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.

Understand the indications for ventilation.
→Recognize apnea or bradycardia of less than 100/min after initial steps of resuscitation.

Preparation

Post
Resuscitation
care

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Check for critical knowledge and performance

Knowledge

NO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

4 -3 Ventilation (T-piece resuscitator)NAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

YES
・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HR(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.

(c) PPV 30/min. and chest compression 90/min

Pre-training
check.

Understand that eﬀective ventilation should be initiated by 60 seconds of lifeat the latest if the child does not respond to the initial steps of resuscitation
Understand the oxygen concentration to use when initiating ventilation in term neonates.
→21％（room air）
Check gas supplies at delivery room (oxygen or air or mixed gas).
Connect the gas supply and T-piece resuscitator (tube of gas supply or piping tube).
Set the dedicated circuit.
Set the ﬂow rate to approximately 5 to 10 mL/min.
Set the peak inspiratory pressure (PIP) to 20 to 30 cmH2O
and the PEEP to 5cmH2O by using a test bag.
Understand criteria to select the mask size.
→Select appropriate mask size (cover the neonate s nose and mouth but not the eyes.)
Keep sniﬃng position with shoulder roll (assess the open airway).
Hold the neonate s jaw and the mask with the IC clamp technique.

Skill

Put the mask on the neonate s face and keep airtight seal.
Provide ventilation at a rate of 40 to 60 breaths per minutes by opening
and closing the expiratory valve opening.
Check chest movements.

6

・Carefulobservation
on respiration(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.

Understand the indications for ventilation.
→Recognize apnea or bradycardia of less than 100/min after initial steps of resuscitation.

Preparation

Post
Resuscitation
care

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Check for critical knowledge and performance

Knowledge

NO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

4 -4 Corrective ventilation steps
NAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

YES
・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊

Knowledge

Skill(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.

(c) PPV 30/min. and chest compression 90/min

Pre-training
check.

Check heart rate improvement.
Re-check chest movements.
Check end-tidal CO2(while the neonate is intubated).

Check sniﬃng position for airway management.
Perform oral/nasal suctioning.
Increase ventilation pressure.
Consider alternative airway.

7

・Carefulobservation
on respiration(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.

Check airtight seal between the mask
and the neonate s face
(Check the IC clamp technique).
Solve problems by using
these corrective steps
when the ventilation is
not eﬀective.

Post
Resuscitation
care

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Check for critical knowledge and performance

Understand three indicators
for assessing
the achievement ofeﬀective ventilation.

・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HRNO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

5 - 1 Chest compressions (two-thumb technique)NAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)

YES・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HR(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.

(c) PPV 30/min. and chest compression 90/min

Pre-training
check.

Understand to increase oxygen when initiating chest compressions.
Understand indications for stopping chest compressions.
→When the heart rate is more than 60/min.
Encircle the chest with the two hands leaving the thumbs on the chest.
Administer compressions on the middle third of the sternum.
Administer compressions to a depth of one-third of
the anterior-posterior diameter of the chest.
Do not remove the ﬁngers from the chest even when releasing pressure.
Administer three compressions followed by one ventilation(each cycle is performed over a period of 2 seconds).
Administer 90 chest compressions and 30 rescue breaths in a minute.
The care provider performing chest compressions act as pacemakers.

8・Carefulobservation
on respiration(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.

Understand indications for chest compressions.
→When the heart rate is less than 60/min despite eﬀective ventilation for 30seconds.

Skill

Post
Resuscitation
care

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Check for critical knowledge and performance

Knowledge

NO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

5 - 2 Chest compressions (two-ﬁnger technique)NAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)

YES・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HR(c) PPV 30/min. and chest compression 90/min

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Pre-training
check.

Understand to increase oxygen when initiating chest compressions.
Understand indications for stopping chest compressions.
→When the heart rate is more than 60/min.
Administer chest compressions with two ﬁngers, either the index ﬁnger
and middle ﬁnger or the middle ﬁnger and ring ﬁnger.
Place the other hand or a massage board on the neonate s back.
Administer compressions on the lower third of the sternum.
Administer compressions to a depth of one-third of the anterior-posterior
diameter of the chest.
Do not remove the ﬁngers from the chest even when releasing pressure.
Administer three compressions followed by one ventilation(3 to 1 ratio with 2 seconds for each cycle).
Administer 90 chest compressions and 30 ventilations in a minute.
The care provider performing chest compressions act as pacemakers
by saying the rhythm aloud.

9

・Carefulobservation
on respiration(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.

Understand indications for chest compressions.
→When the heart rate is less than 60/min despite eﬀective ventilation for 30 seconds.

Skill

Post
Resuscitation
care(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.

Check for critical knowledge and performance

Knowledge

NO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

6 - 1 Intravenous adrenaline administrationNAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

YES
・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HR(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.

(c) PPV 30/min. and chest compression 90/min

Pre-training
check.

Understand the route for intravenous adrenaline administration(umbilical vein, intraosseous route, peripheral vein).
Understand the dose of adrenaline for intravenous administration.
→Ten-fold diluted adrenaline (0.01%): 0.1 to 0.3mL/kg

Dilute one ampule (1 mL) of adrenaline (0.1%) by a factor of 10 using 9 mLof normal saline (10 mL total) to prepare 10-fold diluted adrenaline (0.01%).

Administer a dose of 10-fold diluted adrenaline rapidly.

Skill

Flush the route with normal saline to ensure the administrationof the entire dose after administering the adrenaline.
Assess the heart rate every 30 seconds after adrenaline administration.
If the heart rate remains less than 60/min, administer additionaldoses every 3 to 5 minutes.

10

・Carefulobservation
on respiration(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.

Understand indications for adrenaline administration.
→When the heart rate is less than 60/min despite eﬀective ventilationand chest compression.

Preparation

Post
Resuscitation
care

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Check for critical knowledge and performance

Knowledge

NO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

6 - 2 Endotracheal adrenaline administrationNAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

YES
・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HR(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.

(c) PPV 30/min. and chest compression 90/min

Pre-training
check.

Understand that endotracheal administration is the second-best approach.
Understand the dose of adrenaline for endotracheal administration.
→Ten-fold diluted adrenaline (0.01%)：0.5 to 1.0mL/kg

Dilute one ampule (1 mL) of adrenaline (0.1%) by a factor of 10 using 9 mLof normal saline (10 mL total) to prepare 10-fold diluted adrenaline (0.01%).
Ensure that no drug solution remains in the endotracheal tube or any of
the connecting tubes after administering adrenaline.

Skill

Initiate ventilation promptly after administration to promote absorption of
the drug through the trachea.
Assess the heart rate approximately every 30 seconds after administration.
If the heart rate remains less than 60/min, administer additional doses
every 3 to 5 minutes.

11

・Carefulobservation
on respiration(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.

Understand indications for adrenaline administration→When the heart rate is less than 60/min despite eﬀective ventilationand chest compression.

Preparation

Post
Resuscitation
care

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Check for critical knowledge and performance

Knowledge

NO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

7 - 1 Intravenous volume expanders administrationNAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

YES
・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HR・Carefulobservation
on respiration(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.
(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.
(c) PPV 30/min. and chest compression 90/min

Pre-training
check.

Understand indications for volume expanders administration.
→When a neonate has obvious drop in circulating blood volume despite ventilation,
chest compressions and adrenaline administration.
Understand that normal saline is the recommended volume expander to use.
Understand that the other recommended volume expanders are lactated Ringer ssolution and type O Rh-negative.
Understand that type O Rh-negative packed red blood cells can be used
if the neonate might have had anemia during the fetal period.
Understand the dose of volume expanders (10mL/kg).

Administer volume expanders intravenously over a period of 5 to 10 minutes.

Skill
Administer the same dose if the response is inadequate.

12

Post
Resuscitation
care

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Check for critical knowledge and performance

Knowledge

NO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

7 - 2 Intravenous sodium bicarbonate administrationNAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

YES
・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HR(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.

(c) PPV 30/min. and chest compression 90/min

Pre-training
check.

Understand the dose of sodium bicarbonate.
→Two-fold diluted sodium bicarbonate：2 to 4 mL/kg
Understand that the route of sodium bicarbonate administration is intravenous.

Skill

Dilute sodium bicarbonate with distilled water by a factor of two.

Administer sodium bicarbonate solution intravenously at a rate of at least 1 mL/kg/min(over a period of 2 to 4 minutes).

13

・Carefulobservation
on respiration(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.

Understand indication for sodium bicarbonate administration.
→When there is an apparent metabolic acidosis preventing hemodynamic
improvement despite adequate ventilatory management.

Preparation

Post
Resuscitation
care

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Check for critical knowledge and performance

Knowledge

NO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

8 - 1 CPAPNAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

YES
・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.

(c) PPV 30/min. and chest compression 90/min

Pre-training
check.

Understand indications for CPAP.
→When the respiratory distress with labored breathing or poor
oxygenation (cyanosis or low SpO2) persists.

Prepare a ﬂow-inﬂating bag or a T-piece resuscitator.
Select appropriate mask size
(cover the neonate s nose and mouth but not eyes).
Keep sniﬃng position with shoulder roll (assess the airway).

Skill

Hold the neonate s jaw and the mask with the IC clamp technique.
Put the mask on the neonate s face and keep airtight seal.
Adjust PEEP to 5 to 6 cmH2O and avoid PEEP of more than 8 cmH2O.

14

・Carefulobservation
on respiration(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.

Understand to intiate CPAP with room air in term and near-term infants.

Preparation

Post
Resuscitation
care

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Check for critical knowledge and performance

Knowledge

・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HRNO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

8 - 2 Free-ﬂow oxygen
NAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)

YES・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HR・Carefulobservation
on respiration(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.
(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.
(c) PPV 30/min. and chest compression 90/min

Pre-training
check.

Knowledge

Understand indication for free-ﬂow oxygen.
→①Persistent poor oxygenation (cyanosis or low SpO2)→②If only labored breathing persists, the free-ﬂow oxygen can be used
as a second option when CPAP can t be provided

Preparation

Prepare an oxygen tube, a ﬂow-inﬂating bag, or a T-piece resuscitator.
（Do not use a self-inﬂating bag to administer free ﬂow oxygen.）

When using an oxygen tube, administer oxygen by holding the oxygen tube
close to the neonate s nose and mouth with a hand cupping.
When using a ﬂow-inﬂating bag or a T-piece resuscitator, administer oxygenby holding the mask close to the neonate s nose and mouth.

Adjust the oxygen concentration while assessing SpO2.

15

Post
Resuscitation
care

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Check for critical knowledge and performance

Skill

NO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

9 - 1 Endotracheal intubationNAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

YES
・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊

Preparation(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.

(c) PPV 30/min. and chest compression 90/min

Pre-training
check.

Understand indications for endotracheal intubation.
Prepare appropriate supplies for endotracheal intubation.
Select appropriate size of the endotracheal tube.

Hold the laryngoscope with your left hand.
Advance the blade tip beyond the base of the tongue to a position where it holds the epiglottis.
Lift the blade slightly to lift the tongue and expose the pharyngeal area.
＊Do not lift the tip of the blade alone.
Look for anatomical landmarks.
Hold the tube with your right hand.
Insert from the right corner of the neonate s mouth while keeping the curve of the tube horizontal.
Insert the tube to the point where the vocal cord guide reaches the vocal cords.
Carefully withdraw the laryngoscope while keeping the tube securely in place with your right hand.
Intubation attempt should be performed within 20 seconds.
Check the length of tube is 6cm+BW(kg) at the corner of the mouth.
Check the tip of the tube is properly positioned between the vocal cords and the carina.
Secure the tube with tape or another securing device.

16

・Carefulobservation
on respiration(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.

Keep sniﬃng position without the shoulder roll or with the thin towel under the back of head.

Skill

Post
Resuscitation
care

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Check for critical knowledge and performance
Knowledge

・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HRNO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

9 - 2 Laryngeal mask (LM)NAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

YES
・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.

(c) PPV 30/min. and chest compression 90/min

Pre-training
check.

Understand indications for LM.
→When ventilation with a face mask is not eﬀective in neonates over 34 weeks gestation.

Prepare the appropriate size of the tube.

→The size 1 LM can be used for neonates weighing 2 to 5 kg.

If using an LM with a cuﬀ, inﬂate the cuﬀ before inserting for pre-use inspection.
If using an LM with a cuﬀ, fully deﬂate the cuﬀ before inserting.
Keep sniﬃng position with shoulder roll (assess the open airway).
Place the index ﬁnger on the tip of the mask opening and hold the LM with two ﬁngers.
Use the other hand to open the neonate s mouth and advance the LM along
the hard palate with the index ﬁnger until it meets resistance.

Skill

Remove the index ﬁnger while supporting the tube with one hand.
If using an LM with a cuﬀ, inﬂate the cuﬀ with the designated amount of air.
Conﬁrm appropriate placement of the LM tip by ﬁve-point auscultation or observing the chest
movements, exhaled CO2 detected with an end-tidal CO2 monitor or capnometer.
Secure the LM with tape.

17

・Carefulobservation
on respiration(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.

Prepare appropriate supplies.

Preparation

Post
Resuscitation
care

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Check for critical knowledge and performance
Knowledge

・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HRNO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

10 Resuscitation of preterm infants
NAME

NCPR2020 Algorithm
Team briefing,
PPE, and Equipment check

MEMO

Target SpO2
Time
1min.
3min.
5min.
10min.

Birth・Preterm?
・Weak respiration?
・Weak tone?

NO
Routine Care(stay with mother)・ Provide warmth・ Open airway
・ Dry
Ongoing evaluation

YES
Warm,
open airway (positioning, etc.),
dry, and stimulate
Within60 seconds

Spontaneous breathingandHR≥100/min.
Labored breathing or

Breathing ・HR(Consider SpO2
monitoring)

YES・PPV (a)・SpO2 monitoring
・Consider ECG monitoring

・Check ventilation (b)・Consider intubation

・SpO2 monitoring
・CPAP or O2 as needed

60/min≤HR<100/min.

HR

Improving

Not
Improving

PPV(+O2) + Chest compression (1:3) (c)・ Search for the cause
and…

HR≥ 60/min.

・Consider PPV if laboredbreathing and low SpO2
continues.

HR<60/min.
Consider IV adrenaline

HR<60/min.
PPV + Chest compression and…..
・ Normal saline for suspected hypovolemia
・ Searching for the cause of cardiac arrest
After ROSC (HR ≥ 60/min.)Stop chest compression and continue PPV＊・Check congenital heartdisease if low SpO2
continues without laboredbreathing.

HR≥ 60/min.

HR・Carefulobservation
on respiration(a) Add or increase supplemental oxygen if HR
or SpO2 are not improved.

(c) PPV 30/min. and chest compression 90/min

Check if you understand or can perform the item well before training.
Check if you understood or performed the item well after training.

Pre-training
check.

Delayed cord clamping for longer than 30 seconds is suggested forpreterm infants not requiring immediate resuscitation.
Cord milking that does not impede resuscitation is considered a reasonable alternative inpreterm infants born at 28 weeks of gestation or less who require immediate resuscitation.
Perform resuscitation procedures under a radiant warmer in preterm infants born between
28 and 32 weeks of gestation, a combination of other methods such as warm blankets,
plastic wrap, and a thermal mattress should be used while keeping room temperature
at 23 to 25°
C to avoid hypothermia (body temperature <36°
C).
Provide CPAP before intubation and ventilation in preterm infants
who have labored breathing.
Initiate ventilation with low oxygen (21 to 30%) in preterm infants bornat less than 35 weeks of gestation.
Use a PEEP of 5 cmH2O if ventilation is indicated for a preterm infant
in the delivery room.

18

Post
Resuscitation
care(b) If the ventilation is not optimal,
focus on improving ventilation before
proceeding to the chest compressions.

Check for critical knowledge and performance

Knowledge

NO

Labored breathing or
cyanosis (low SpO2)

HR<60/min.

HRNOcyanosis (low SpO2)

Apnea /Gasping or
HR <100/min.

HR≥100/min.

SpO2 (%)
≥60
≥70
≥80
≥90

Post-training
check.

NCPR S course scenario（Ventilation）
NAME

TEAM
※

Team brieﬁng
PPE
Equipment check

Check the items that your teamappropriately assessed andperformed

Birth

1

Preterm …………

Weak respiration…
Weak tone ………

Within60 sec.

weeks

Yes

No

Initial steps of resuscitation
Provide warmth
Ensure open airway
Dry
Stimulation

2

5

Assessment
Breathing… Yes

No

HR …………

/min

Ventilation
SpO2 monitor
Considering ECG monitor

3

Assessment
Breathing… Yes
HR …………

Assessment
Labored breathing…
Cyanosis …………

Yes

No

Post-resuscitation care

No
/min

Ventilation and chest compression（Consider endotracheal intubation）

4

Assessment
Breathing… Yes
HR …………

No/min

Consider consistentthermal management

Stop ventilation

The goals for the next time

Check-points for better resuscitation
Did you have a constructive decision making
with all team member?
Did you make another suggestion when the leader's
instructions and opinions are conﬂict with yours?
Did you communicate well with other team members
during resuscitation?
Did you help each other to solve issues in resuscitation?

19

NCPR S course scenario（Chest compression）
NAME

TEAM
※

Team brieﬁng
PPE
Equipment check

Check the items that your teamappropriately assessed andperformed

Birth

1

Preterm …………

Weak respiration…
Weak tone ………

Within60 sec.

weeks

Yes

No

Initial steps of resuscitation
Provide warmth
Ensure open airway
Dry
Stimulation

2

Assessment
Breathing… Yes
HR …………

No

5

/min

Ventilation
SpO2 monitor
Considering ECG monitor

3
Checkeﬀective
ventilation

6

Assessment
Breathing… Yes

No

HR …………

/min

Assessment
Breathing… Yes
HR …………

No/min

Continue ventilation

Ventilation and chest compression（Consider endotracheal intubation）
Oxygen concentrarion

4

Assessment
Breathing… Yes
HR …………

No/min

Assessment
Breathing… Yes
HR …………

No/min

Transport to NICU

Consider consistentthermal management

Stop chest compressions

The goals for the next time

Check-points for better resuscitation
Did you predict and prepare
the next action during resuscitation?
Did you complete your assigned roles appropriately
under the leadership?
Did you state your action clearly during resuscitation?
Did you check and evaluate
the resuscitation techniques each other?

20

NCPR S course scenario（CPAP）
NAME

TEAM
※

Team brieﬁng
PPE
Equipment check

Check the items that your teamappropriately assessed andperformed

Birth

1

Preterm …………

Weak respiration…
Weak tone ………

Within60 sec.

weeks

Yes

No

Initial steps of resuscitation
Provide warmth
Ensure open airway
Dry
Stimulation

2

3

Assessment
Breathing… Yes

No

HR …………

/min

Assessment
Labored breathing…
Cyanosis …………

Yes

No

SpO2 monitor

Consider CPAP or free-ﬂow oxygen

4

Assessment
Labored breathing…
Cyanosis …………

Yes

No

Post-resuscitation care

Consider consistentthermal management

The goals for the next time

Check-points for better resuscitation
Did you have a constructive decision making
with all team member?
Did you make another suggestion when the leader's
instructions and opinions are conﬂict with yours?
Did you communicate well with other team members
during resuscitation?
Did you help each other to solve issues in resuscitation?

21

NCPR S course scenario（medications）
NAME

TEAM
※

Team brieﬁng
PPE
Equipment check

Check the items that your teamappropriately assessed andperformed

Birth

1

Preterm …………

Weak respiration…
Weak tone ………

Within60 sec.

weeks

Yes

No

Initial steps of resuscitation
Provide warmth
Ensure open airway
Dry
Stimulation

2

5

Assessment
Breathing… Yes

No

HR …………

/min

Ventilation
SpO2 monitor
Considering ECG monitor

3
Checkeﬀective
ventilation

Assessment
Breathing… Yes
HR …………

No/min

Stop chest compressions

6

Assessment
Breathing… Yes

No

HR …………

/min

Assessment
Breathing… Yes
HR …………

No/min

Continue ventilation

Ventilation and chest compression（Consider endotracheal intubation）
Oxygen concentrarion

4

Assessment
Breathing… Yes

No

HR …………

/min

Adrenaline administration

7

Assessment
Breathing… Yes
HR …………

No/min

Transport to NICU

Consider consistentthermal management

The goals for the next time

Check-points for better resuscitation
Did you predict and prepare the next action
during resuscitation?
Did you complete your assigned roles appropriately
under the leadership?
Did you state your action clearly during resuscitation?
Did you check and evaluate the resuscitation
techniques each other?

22

NCPR S course scenario（
NAME

）

TEAM
※

Team brieﬁng
PPE
Equipment check

Check the items that your teamappropriately assessed andperformed

At Birth
Preterm …………
Weak respiration…
Weak tone ………

weeks

Yes

No
Routine Care(stay with mother)

Initial steps of resuscitation
Provide warmth
Ensure open airway
Dry
Stimulation

Within60 sec.

Assessment
Breathing… Yes
HR …………

Assessment

No

Labored breathing…
Cyanosis …………

/min

Ventilation
SpO2 monitor
Considering ECG monitor

Checkeﬀective
ventilation

Assessment
Breathing… Yes

No

HR …………

/min

No

HR …………

/min

Yes

Consider CPAP or free-ﬂow oxygen

Assessment
Labored breathing…
Cyanosis …………

Yes

Post
Resuscitation care

Searching for cause of
cardiac arrest
Consider PPV if laboredbreathing and low SpO2
continues.

No

HR …………

/min

No・Careful observation on
respiration

IV adrenaline
Assessment
Breathing… Yes

No

SpO2 monitor

Ventilation and chest compression（Consider endotracheal intubation）
Oxygen concentrarion
Assessment
Breathing… Yes

Provide warmth
Ensure open airway
Dry
Ongoing evaluation

Check congenital heartdisease if low SpO2
continues without laboredbreathing.

PPV + Chest Compression and……

□ Searching for cause of cardiac arrest□ Normal Saline as Volume Expander

After ROSC (HR ≥ 60/min.)Quit Chest Compression and continue PPV

23

Consider consistentthermal management