Delivery Room Resuscitation Note (NRP)

Date: [Date]

Location: [L&D room / OR / birthing center / other]

Infant: [Name or temporary identifier], [Sex], [MRN if assigned]

Gestational Age: [Weeks+days]

Birthweight: [Weight in grams] (Indicate if estimated)

Birth Time: [Clock time]

Cord Clamped: [Time clamped or duration of delayed clamping / unknown]

Resuscitation Team: [Team members with assigned roles: team leader, airway, recorder, compressor, medications/access as applicable]

Reason for Attendance

[Requesting clinician/service] requested [planned standby / emergent] attendance for [primary indication(s) for attendance]. [Interventions beyond routine newborn care were / were not] required.

Pre-brief and Preparation

[Antenatal risk summary relevant to resuscitation planning]. Planned cord management: [deferred clamping / immediate clamping with rationale]. Equipment readiness verified. (If precipitous delivery with no formal pre-brief, document that roles were assigned upon arrival.)

Delivery and Initial Context

[Mode of delivery]. Amniotic fluid [clear / meconium-stained / bloody]. [Delayed cord clamping performed for duration / immediate clamping performed due to indication]. Infant placed [skin-to-skin / on radiant warmer]. Thermal management: [measures used].

Initial Condition at Birth

Tone: [good / poor]. Breathing: [crying / spontaneous adequate / apnea / gasping / ineffective effort]. Heart Rate: [value] by [auscultation / ECG / pulse oximetry]. SpO2: [value or not yet available] at [preductal right hand/wrist / other site]. (If resuscitation initiated, state trigger: [apnea / HR <100 / HR <60 / persistent cyanosis below target saturation / other].)

Resuscitation Summary

[Concise 3–7 sentence synopsis: what prompted resuscitation, highest level of support provided, response trajectory including HR changes and SpO2 trend, onset of spontaneous respirations if applicable, and condition at disposition.]

Resuscitation Timeline

(Document time-stamped entries using minutes:seconds since birth with Time 0 = birth. Include clock time if available. Record entries at minimum for: birth/initial assessment, PPV initiation, airway interventions, compressions start/stop, medication administration, and end of resuscitation. If exact timing was not recorded contemporaneously, document "time not recorded.")

• [mm:ss] ([clock time]) — HR: [value] by [method]; Resp: [status]; SpO2: [value]; FiO2: [value]; Intervention: [action]; Comments: [response/findings]
• [mm:ss] ([clock time]) — HR: [value] by [method]; Resp: [status]; SpO2: [value]; FiO2: [value]; Intervention: [action]; Comments: [response/findings]
• (Add entries for each key event and response)

Respiratory Support Details

(Include only if support beyond initial steps was provided.)

Initial steps: [warm / dry / position / stimulate / clear airway as indicated]; effectiveness: [effective / not effective].

Suctioning: (Include only if performed) Indication: [visible obstruction / secretions interfering with ventilation]; method: [bulb / catheter]; outcome: [cleared / persistent obstruction].

Pulse oximetry: Sensor at [preductal right hand/wrist / other site]; NRP target saturation table referenced.

CPAP: (Include only if used) Indication: [indication]; interface: [mask / prongs]; level: [cm H2O]; FiO2: [value]; response: [work of breathing, SpO2, HR changes].

PPV: (Include only if used) Started at [mm:ss]; device: [T-piece / bag-mask]; settings: PIP [cm H2O], PEEP [cm H2O], rate [breaths/min], FiO2 [initial and titration]. Chest rise: [yes / no]. HR response: [describe]. Corrective steps if needed: [reposition airway / mask adjustment / two-person technique / suction / increase pressure / alternative airway].

Advanced airway: (Include only if used) Indication: [indication]; device: [ETT / LMA] size [size]; attempts: [number] by [clinician]; confirmation: [colorimetric CO2 / auscultation / chest rise]; ETT depth at lip: [cm]; complications: [none / describe].

Chest Compressions

(Include only if compressions were performed.)

Trigger: HR [value] by [method]. Started at [mm:ss], stopped at [mm:ss / ongoing at transfer]. Technique: [two-thumb encircling] with 3:1 coordination. FiO2 during compressions: [value]. Response: [HR changes, ROSC time if applicable].

Vascular Access and Medications

(Include only if vascular access was obtained or medications/fluids were administered.)

Vascular access: [UVC / IO], [catheter size], depth [cm] for UVC, achieved at [time]; complications: [none / describe].

Epinephrine: (Include only if given) Indication: [persistent HR <60 despite adequate ventilation and compressions]; route: [IV/UVC/IO / ETT while obtaining access]; dose: [mg/kg] ([mL]); time: [time] with flush; HR response: [describe]. (Repeat for additional doses.)

Volume expansion: (Include only if given) Indication: [suspected blood loss / hypovolemia / poor response]; fluid: [type]; volume: [mL/kg]; response: [describe].

Apgar Scores

(Document at 1 and 5 minutes for all infants. Continue at 5-minute intervals if 5-minute score <7 or per institutional policy. Include concurrent interventions to contextualize each score. Document "not recorded" if score was not assigned.)

• 1 minute: [total score] ([A/P/G/A/R components]); concurrent interventions: [oxygen / CPAP / PPV / intubation / compressions / epinephrine / none]
• 5 minutes: [total score] ([components]); concurrent interventions: [list]
• 10 minutes: (Include if indicated) [total score] ([components]); concurrent interventions: [list]
• 15 minutes: (Include if indicated) [total score] ([components]); concurrent interventions: [list]
• 20 minutes: (Include if indicated) [total score] ([components]); concurrent interventions: [list]

Post-resuscitation Status and Disposition

Condition at end of resuscitation: HR [value], RR [value] with [effort], SpO2 [value] on FiO2 [value], temperature [value] by [method].

Respiratory support at transfer: [room air / nasal cannula at L/min / CPAP at cm H2O / ventilator with mode and settings].

Disposition: [remained with parent / newborn nursery / NICU / transfer to higher level of care].

Immediate next steps: [glucose check timing, blood gas/labs obtained, therapeutic hypothermia evaluation if applicable per protocol].

Handoff

Verbal handoff provided to [name and role]. Questions addressed.

Illness severity: [stable / needs monitoring / unstable]. Summary: [why resuscitation occurred and what was done]. Action items: [labs / imaging / temperature management / antibiotic evaluation / other]. Contingency plans: [key plans communicated].

Family Communication

Family [updated / not yet updated] by [name and role]. Key points communicated: [infant condition, disposition, next steps]. (If not updated, document reason and plan for communication.)

(General guidance: Document "unknown" or "not recorded" for information not observed rather than leaving blank or inferring. Do not infer effective ventilation without documented chest rise or HR improvement. For multiple gestations, generate separate note for each infant [Baby A, Baby B].)