Elsevier

Resuscitation

Volume 75, Issue 2, November 2007, Pages 345-349
Resuscitation

Training and educational paper
Neonatal resuscitation—An analysis of the transatlantic divide☆

https://doi.org/10.1016/j.resuscitation.2007.05.001Get rights and content

Summary

Aim

To highlight the main differences between the current editions of the Newborn Life Support (NLS; Resuscitation Council, UK) and the Neonatal Resuscitation Program (NRP; American Academy of Pediatrics and American Heart Association), and to analyse differences between the evidence underlying NLS and NRP.

Material and methods

We undertook a detailed comparison of recommendations and references, based on the NLS and the NRP provider course manuals issued in 2006. Literature on neonatal resuscitation, published in 2005 and thereafter, was searched, focusing on controversies between NLS and NRP.

Results

A multitude of important differences between NLS and NRP have been reaffirmed in their current editions, leading to conflicting messages regarding many aspects of resuscitation. An incongruent selection of evidence appears to be a major factor accounting for this divergence.

Conclusion

To avoid confusion among health care providers and to support the credibility of both NLS and NRP, an intensified dialogue and a more congruent evidence base between NRP and NLS is required. Mutual recognition of equivalency appears unrealistic until substantial progress in this direction has been achieved.

Introduction

National guidelines for neonatal resuscitation have been published as Neonatal Resuscitation Program (NRP1) in the United States and as Newborn Life Support (NLS2) in the United Kingdom. Since the first NRP course was taught in 1987, the NRP has not only achieved widespread coverage of its target groups in the United States, but it has also developed into a decidedly international undertaking, with NRP courses, now in their 5th edition, being taught in over 90 countries. The NLS was launched in Britain in 2001, and has established itself as the national standard in the United Kingdom. NLS courses have also been taught in other countries, albeit not to the extent of the NRP. Both the current 2nd edition of the NLS and the 5th edition of the NRP were issued in 2006 and refer to updated resuscitation guidelines by ILCOR3. Nevertheless, a multitude of differences between the two systems has persisted. These differences are particularly disturbing for an increasing number of neonatal health workers pursuing international careers, working consecutively in Britain, the United States and/or other countries where NRP and/or NLS are being practiced. Even in Britain the NRP has started to co-exist with the NLS, exposing nursing and medical staff to conflicting messages, depending on their place of training. Awareness of these controversial issues is a first step in order to find the “better of two options”, if not a compromise between them. This article tries to highlight and analyse the differences between the approaches recommended by the NLS and the NRP, in order to assist future efforts towards more congruency.

Section snippets

Material and methods

Based on the NLS Provider Course Manual2 and on the Neonatal Resuscitation Textbook (i.e. NRP provider course manual)1, the most significant differences regarding interventions and equipment were identified (Table 1), and evidence and opinion that has recently emerged on these differences was searched among publications from 2005 onwards (http://www.pubmed.gov/). All references listed in the NLS and NRP provider course manuals were compared in order to determine the amount of overlap (Figure 1

Results

Areas of divergent recommendations were identified for many aspects of resuscitation (Table 1), with considerable clinical relevance. Several recent publications4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 have provided new evidence or comments on these controversial issues. Between the 175 references listed in the NLS manual2 and the 107 references used in the NRP text1, only 27 were shared (Figure 1). The comparison regarding their year of publication (Figure 2) revealed differences in the

Discussion

It is not within the scope of our analysis to evaluate the respective bodies of evidence of NRP and NLS, or to critique conclusions drawn from this evidence. Controversies regarding neonatal resuscitation have persisted over the last decades, and the need to strengthen and broaden the evidence base underlying various recommended interventions is obvious4. New evidence, which may be supportive of either the positions of the NRP, or of the NLS, is accumulating continuously, e.g. on digital

Conclusion

Persisting important differences between NRP and NLS may be largely due to the incongruent selection of evidence. The co-existence of such diverging guidelines represents a hazard whenever a newborn is resuscitated by a “mixed” team; it also impairs the credibility of either one of the two approaches to neonatal resuscitation. Mutual recognition and equivalency between NRP and NLS appears unrealistic at present. In order to avoid conflicting messages on neonatal resuscitation, an intensified

Conflict of interest

No author has a conflict of interest in regard to the teaching materials, drugs and equipment discussed in this manuscript.

References (14)

There are more references available in the full text version of this article.
☆

A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2007.05.001.

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