The Neonatal Resuscitation Program (nrp) is a joint initiative of the American Academy of Pediatrics (AAP) and the American Heart Association (AHA). It was developed to teach evidence-based skills for resuscitating newborns in the delivery room and other clinical settings where births occur.
Established in 1987, nrp certification has become a standard credential for healthcare providers who may be present at a delivery. The program is based on the International Liaison Committee on Resuscitation (ILCOR) guidelines and is updated every five years to reflect the latest science.
NRP focuses on the critical first minutes of life. Approximately 10% of newborns require some assistance breathing at birth, and about 1% require extensive resuscitation. Trained providers can dramatically improve outcomes by acting quickly and correctly with the NRP algorithm and skills.
Any healthcare professional who may be called upon to resuscitate a newborn should hold current nrp certification. This includes a wide range of clinical roles across hospital and birth center settings.
Many hospital credentialing bodies, state nursing boards, and clinical practice organizations require proof of current nrp program completion as a condition of clinical privileges. Some travel nursing agencies also require NRP for L&D and NICU placement.
The NRP certification process has three main components, all of which must be completed to receive your provider card.
All candidates begin with the NRP eLearning online course through the AAP. This self-paced module covers the science and principles behind neonatal resuscitation. After completing the lessons, you take the online cognitive assessment — a multiple-choice test covering the nrp algorithm, equipment, and clinical decision-making. You must score 80% or higher to advance.
At a face-to-face course, an NRP instructor evaluates your hands-on skills. You will demonstrate proper bag-mask ventilation, endotracheal intubation, use of a laryngeal mask, umbilical catheter insertion, and other core resuscitation skills on a mannequin. Each skill is scored against a standardized checklist.
You participate in at least one simulation-based resuscitation scenario with a team. The scenario tests your ability to apply the NRP algorithm in real time, communicate with teammates, and make rapid clinical decisions. Debriefing follows every simulation to reinforce learning.
Upon successfully completing all three components, you receive an NRP Provider card issued by the AAP, valid for two years from the date of your face-to-face course.
The nrp algorithm follows a sequential decision tree that providers apply in the first minutes of life. Understanding each step is essential for both passing the course and performing well in clinical situations.
At birth, providers immediately answer four questions: Is the baby term gestation? Does the baby have good muscle tone? Is the baby breathing or crying? If YES to all three, the baby stays with the mother for routine care. If NO to any question, the baby moves to the radiant warmer for the initial steps. Initial steps include: warm and dry the infant, stimulate by rubbing the back or flicking the soles of the feet, position the airway in a sniffing position, suction only if secretions are obstructing the airway, and apply a cardiac monitor and pulse oximeter.
If the infant is apneic, gasping, or has a heart rate below 100 bpm after initial steps, begin PPV immediately. PPV is delivered at 40-60 breaths per minute using a bag-mask device or T-piece resuscitator. Each breath should produce visible chest rise. If the chest does not rise, use the MR SOPA corrective steps (Mask adjustment, Reposition airway, Suction, Open mouth, Pressure increase, Airway alternative).
If the heart rate remains below 60 bpm after 30 seconds of effective PPV with supplemental oxygen, begin chest compressions. Use the two-thumb technique encircling the chest. Compress one-third the anteroposterior diameter of the chest at a 3:1 compression-to-ventilation ratio (90 compressions + 30 ventilations per minute). Reassess heart rate every 60 seconds.
If the heart rate remains below 60 bpm despite effective compressions and ventilation, administer epinephrine at 0.01-0.03 mg/kg IV via umbilical venous catheter. Volume expansion with normal saline (10 mL/kg) may be given if hypovolemia is suspected.
There are two levels of nrp neonatal resuscitation certification. NRP Provider is the standard credential for clinical staff who attend deliveries, valid 2 years. NRP Instructor is for experienced providers who teach courses, valid 4 years, requiring affiliation with an AAP-approved training center.
NRP provider courses typically cost $65-$120. Hospital employers often cover the cost. Certification is valid for 2 years. Renewal requires completing the current eLearning cognitive assessment and attending an updated face-to-face course. To find a course, use the AAP NRP course locator at the AAP website and search by zip code.