Shock unresponsive to Neonatal Resuscitation Program interventions

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Figure 1.
Neonate electrocardiogram showing regular narrow-complex tachycardia (reconstruction)

Table 1.

The VEB approach to NRP-unresponsive shock: In addition to standard NRP procedures, the following may be attempted with appropriate judgment.

	VALIDATE (RECONFIRM) INFORMATION	ESCALATE (INTERVENTIONS AND CALLS FOR HELP)	BROADEN (DIAGNOSTIC AND THERAPEUTIC CONSIDERATIONS)
Airway and breathing	Ensure that end-tidal carbon dioxide, bilateral breath sounds, and chest rise are definitely present; most neonatal instability is caused by inadequate ventilation¹	Escalate to endotracheal tube insertion if appropriate, especially if doubt exists regarding the proper functioning of supraglottic airway device¹	If deterioration occurs postintubation, consider DOPE mnemonic (displacement, obstruction, pneumothorax, equipment failure)
Circulation	Ensure ECG is monitored¹ and blood pressure is measured (if relevant)	Consider treating hypovolemia by administering a crystalloid bolus (10 mL/kg)¹	Consider broader possible etiologies of shock (Box 1^1,2)