NRP 9th Edition · Study guide
NRP 9th Edition study guide: what to know from every lesson
What each of the 11 NRP 9th Edition lessons covers, plus one table with the numbers worth memorizing. It is free to read, and the demo lets you try the full app.
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How NRP recertification works
Recertification has two parts: an online exam through the AAP and a hands-on skills session with an NRP instructor at your own hospital. This guide helps with the exam. It does not replace the skills session, and PediaSuite does not issue certification.
For a day-by-day schedule, use the one-week study plan. The table and lesson summaries below are the reference to keep next to it.
The numbers to memorize
These are the thresholds, doses and timings that decide what you do next. The last column is the textbook lesson to reread.
| Topic | What to know | Lesson |
|---|---|---|
| Staffing at every birth | At least 1 qualified person whose only job is the newborn. At least 2 if any risk factor is present. | 2 |
| Assisted ventilation indicated | Apnea, gasping, or heart rate below 100 bpm by 1 minute after birth. | 3, 4 |
| Start ventilation | Within 1 minute of birth. | 4 |
| Cord clamping | Deferred at least 60 seconds for most babies who don't need immediate resuscitation. | 3 |
| PPV rate | 30 to 60 breaths per minute. | 4 |
| Initial PIP | 25 cm H₂O. Acceptable 25 to 30 for term and preterm 32 weeks or more, 20 to 25 under 32 weeks. | 4 |
| PEEP, if used | 5 cm H₂O. | 4 |
| Initial FiO₂ | 21% from 35 weeks. 21% to 30% at 32 to 34 weeks. 30% or higher may be considered under 32 weeks. | 4 |
| Start corrective steps (MR SOPA) | Heart rate not rising within 15 to 30 seconds and no chest movement. | 4 |
| Intubation attempt | Ideally completed within about 30 seconds. | 5 |
| Miller blade | No. 1 for term, No. 0 for preterm, No. 00 optional for extremely preterm. | 5 |
| Chest compressions indicated | Heart rate below 60 bpm despite at least 30 seconds of ventilation that moves the chest. | 4, 6 |
| Compression to ventilation ratio | 3:1. That is 90 compressions and 30 breaths per minute. | 6 |
| Compression depth | About one third of the front-to-back diameter of the chest. | 6 |
| Heart rate check during compressions | After 60 seconds of coordinated compressions and ventilation. | 6 |
| Epinephrine indicated | Heart rate below 60 bpm after 30 seconds of ventilation and another 60 seconds of compressions with 100% oxygen. | 7 |
| Epinephrine IV or IO | 0.02 mg/kg (0.01 to 0.03) of 0.1 mg/mL, every 3 to 5 minutes. | 7 |
| Epinephrine endotracheal | 0.1 mg/kg (0.05 to 0.1), only while vascular access is being established. | 7 |
| Volume expander | 10 mL/kg for signs of shock or acute blood loss. | 7 |
| Room temperature, preterm birth | 23 to 25 °C (74 to 77 °F). | 8 |
| Baby under 32 weeks | Polyethylene plastic bag or wrap and a thermal mattress. | 8 |
Prefer cards to paragraphs? The study guide in the NeoCPR demo breaks each topic into a card with the facts, clinical tips and exam details. The demo opens the sections before Airway & Ventilation; the rest is in the full module. No account needed.
Open the study guide demoLesson by lesson
Lesson 1: Foundations of neonatal resuscitation
Most babies need no help: about 85% of term newborns start breathing within 30 seconds of birth, and another 10% respond to drying and stimulation. About 5% receive assisted ventilation, fewer than 1% are intubated, and 1 to 3 per 1,000 receive chest compressions or emergency medications. When a baby does need help, the cause is usually respiratory failure, which is why ventilating the lungs is the most important and effective step. Teamwork, leadership and communication run through every lesson.
Lesson 2: Anticipating and preparing for resuscitation
Ask the obstetric provider the 4 pre-birth questions, hold a pre-resuscitation briefing and check the equipment. Every birth needs at least 1 qualified person whose only job is the newborn, and at least 2 when risk factors are present. Some babies with no apparent risk factors still need resuscitation, so every birth needs a qualified person and working equipment.
Read more: The 4 NRP pre-birth questions
Lesson 3: Initial steps of newborn care
The initial evaluation asks whether the baby is term, has good tone and is breathing or crying. Babies who pass can stay skin to skin with the parent. The others go to the radiant warmer to be warmed, dried, positioned and stimulated, then reassessed by 1 minute. The lesson also covers why routine suctioning is not recommended, deferring cord clamping for at least 60 seconds for most babies who don't need immediate resuscitation, using pulse oximetry to guide oxygen (judging cyanosis by eye is unreliable), when to consider CPAP, and meconium-stained fluid.
Read more: Umbilical cord management, meconium-stained fluid and preductal SpO₂ targets
Lesson 4: Ventilation
Ventilation is the most important step. PPV runs at 30 to 60 breaths per minute with an initial PIP of 25 cm H₂O and PEEP of 5 cm H₂O if used. FiO₂ starts by gestational age and follows the minute-specific SpO₂ targets. A rising heart rate is the best sign that ventilation is working, and if the chest isn't moving you work through MR SOPA. The lesson also compares the self-inflating bag, the flow-inflating bag and the T-piece resuscitator, and covers the laryngeal mask.
Read more: NRP PPV settings, MR SOPA explained and self-inflating bag vs T-piece
Lesson 5: Endotracheal intubation
Intubation is strongly recommended if the heart rate stays below 100 bpm and isn't rising after you optimize mask or laryngeal mask ventilation, and before starting compressions. The lesson covers Miller blade sizes, an attempt time of about 30 seconds, confirming placement with exhaled carbon dioxide and a rapidly rising heart rate, and what to check if the baby worsens afterward (DOPE).
Read more: ETT sizing and tip-to-gum depth and the laryngeal mask airway
Lesson 6: Chest compressions
Compressions are indicated when the heart rate stays below 60 bpm despite at least 30 seconds of ventilation that moves the chest, usually through an endotracheal tube. Give 3 compressions to 1 breath (90 and 30 per minute) with your thumbs on the sternum, pressing about one third of the front-to-back diameter of the chest. Use 100% oxygen, check the heart rate after 60 seconds, and stop compressions once it reaches 60 bpm.
Read more: Neonatal chest compressions and the 3:1 ratio
Lesson 7: Medications
Epinephrine is indicated when ventilation and coordinated compressions have not raised the heart rate to 60 bpm. Use the 0.1 mg/mL concentration at 0.02 mg/kg IV or IO, repeated every 3 to 5 minutes, and give an endotracheal dose (0.1 mg/kg) only while vascular access is being set up. A 10 mL/kg volume expander is for signs of shock or acute blood loss. The lesson also covers when to discuss stopping resuscitation.
Read more: NRP 9th Edition epinephrine, UVC vs IO access and volume expanders
Lesson 8: Resuscitation and stabilization of preterm infants
Preterm babies lose heat quickly and are more vulnerable to hypoglycemia and neurologic injury. Prepare a 23 to 25 °C room, a plastic bag or wrap and a thermal mattress for babies under 32 weeks, and a device that can give PEEP and CPAP. Use the lowest inflation pressure that works, consider CPAP for a baby who is breathing with labored respirations or low saturation, and handle the baby gently.
Read more: Resuscitation under 32 weeks
Lesson 9: Post-resuscitation care
Babies who needed resuscitation need close observation and frequent assessment, and some need a blood gas and glucose and electrolyte checks. Each birth unit needs a way to identify babies who may qualify for therapeutic hypothermia, because treatment has to start promptly. Avoid overheating during and after resuscitation.
Read more: Therapeutic hypothermia and HIE
Lesson 10: Special considerations
Opioid exposure (support ventilation until the baby breathes adequately), a suspected congenital diaphragmatic hernia (avoid face mask ventilation, intubate and place an orogastric tube), choanal atresia, Robin sequence, thick secretions that block the airway, and pneumothorax, pleural effusion and ascites.
Lesson 11: Ethics and care at the end of life
The ethical principles are the same as for older children and adults. Parents take part in decisions when the risk of death or serious morbidity is high, the baby's best interest comes first, and every baby who is not resuscitated or does not survive gets humane, compassionate palliative care.
The textbook also has lessons on improving resuscitation team performance (Lesson 12), resuscitation outside the delivery room (13), quality improvement (14), congenital heart disease (15) and resuscitation in the NICU (16).
Questions about studying for NRP
How does NRP recertification work?
Which numbers should I memorize for the NRP exam?
How long should I study for NRP recertification?
Which lessons should I study first?
Is there a free NRP study guide?
Is this an official NRP study guide?
This page summarizes the NRP 9th Edition textbook for study. It does not replace your NRP course or your hospital's protocols. PediaSuite is independent and is not affiliated with the AAP or AHA.
Keep studying
NRP algorithm walkthrough
The whole 9th Edition path, from the pre-birth questions to epinephrine, with the number behind each step.
Read the walkthrough →NRP flashcards
Twenty sample cards written from the textbook, with the lesson listed under each answer.
Try the cards →NRP practice cases
Three worked cases with the decision points and answers.
Work a case →NRP practice questions
Scenario-based exam questions with tutor and timed exam modes.
Take the practice exam →Try the study guide cards in the free demo.
It is the real NeoCPR app with some content locked. No account or credit card. The full module is a one-time $29 with no subscription.
References
- American Academy of Pediatrics, American Heart Association. Textbook of Neonatal Resuscitation. 9th ed. Itasca, IL: American Academy of Pediatrics; 2025. Lessons 1 to 16.
- Lee HC, Strand ML, Finan E, et al. Part 5: Neonatal Resuscitation: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16 Suppl 2):S385–S423. doi:10.1161/CIR.0000000000001367