3.3 Equipment and Supply Check

Why a Checklist Beats Memory

When a depressed newborn arrives, you will not have time to hunt for a size-0 mask or discover that wall suction is not connected. NRP organizes the pre-birth equipment check so every major algorithm branch has its tools staged: warm the baby, clear the airway if needed, auscultate, ventilate and oxygenate, intubate if needed, and medicate if needed. The mnemonic many programs teach is a variant of Warm → Clear airway → Auscultate → Ventilate → Oxygenate → Intubate → Medicate. Use whatever institutional checklist your unit posts—but the categories below are the content the exam and the algorithm expect.

Perform the check before every birth when possible, and always before an anticipated high-risk delivery. Presence of equipment on a cart is not enough; function must be verified (bag reinflates, blender flows, suction generates vacuum, laryngoscope light works, monitor leads sense a signal).

Warm: Protect Temperature From the First Second

Hypothermia increases oxygen consumption, worsens acidosis, and is associated with poorer outcomes—especially in preterm infants. Warming equipment includes:

• Radiant warmer powered on and pre-warmed before delivery (not switched on after the baby is already wet and cold).
• Warm towels or blankets for drying and stimulation of term and late-preterm infants.
• Hat to reduce heat loss from the large neonatal head surface area.
• Plastic wrap or polyethylene bag for very preterm infants (commonly under about 32 weeks, per unit protocol) to reduce evaporative heat loss—often used with the warmer rather than prolonged open-air drying.
• Temperature probe/servo control so continuous temperature monitoring can guide thermal management after initial stabilization.
• Optional adjuncts depending on setting: thermal mattress, preheated room, and delayed bathing policies after resuscitation.

Exam focus: the warmer is on and ready, not “available somewhere down the hall.”

Clear Airway: Suction Ready at Safe Pressure

Airway clearing tools should be within arm’s reach of the warmer:

• Bulb syringe for simple mouth/nose clearance when indicated.
• Wall or portable suction tested and set to approximately 80–100 mm Hg. Higher pressures risk mucosal injury and vagal bradycardia; untested suction is a classic systems failure.
• Suction catheters in sizes appropriate for term and preterm infants, plus a means to suction an endotracheal tube if obstruction is suspected later.

Remember the clinical rule that accompanies the equipment: vigorous newborns are not routinely suctioned. Equipment readiness supports selective suctioning when secretions obstruct the airway or when PPV is needed—not automatic deep suction of every baby.

Auscultate: Heart Rate and Breath Sounds

• A neonatal/pediatric stethoscope must be on the warmer or around the airway provider’s neck—not in a locker. Early heart-rate assessment by auscultation of the precordium remains fundamental, even when ECG and pulse oximetry are also applied.

Ventilate and Oxygenate: The Core of NRP

Because PPV is the most important action for the nonbreathing or bradycardic newborn, ventilation equipment is non-negotiable:

• PPV device: self-inflating bag, flow-inflating bag, or T-piece resuscitator—whichever your team is trained to use—with a working pressure manometer/settings appropriate to newborns.
• Masks in multiple sizes (term and preterm). A mask that is too large leaks; too small fails to cover mouth and nose correctly.
• Oxygen blender capable of delivering adjusted FiO2 (including low starting oxygen for many term/near-term resuscitations per current guidance, with titration to target saturations).
• Pulse oximeter with neonatal probe (typically right hand/wrist for preductal readings) ready to place when resuscitation is more than brief routine care.
• ECG leads and cardiac monitor for rapid, accurate heart-rate display when the baby requires ongoing intervention—ECG is preferred over pulse oximetry alone for heart-rate assessment during resuscitation.
• Compressed air and oxygen sources confirmed, tubing connected, and backup devices available if a primary bag fails.

Intubate: Alternative Airway Tray

When PPV fails to improve heart rate or an advanced airway is indicated, delay caused by a missing blade is unacceptable. Stage:

• Laryngoscope handle with working light.
• Straight (Miller) blades, commonly size 1 for term, size 0 for preterm, and size 00 for extremely preterm infants (know the concept even if exact unit stock varies).
• Endotracheal tubes in a range of sizes with a method to estimate depth.
• CO2 detector (colorimetric or quantitative) to help confirm tube placement along with clinical signs.
• Laryngeal mask (supraglottic airway) sizes appropriate for newborns when intubation is not feasible or as an alternative airway strategy.
• Tape or tube-securing device, stylet if used by protocol, and a means to suction the tube.

Medicate: Epinephrine, Volume, Access

Medications are needed infrequently, but when heart rate remains below 60 beats per minute despite effective ventilation and compressions, delay is harmful. Check:

• Epinephrine 0.1 mg/mL (1:10,000) — the NRP concentration for neonatal dosing. Do not confuse with the 1 mg/mL (1:1,000) product used for other indications.
• Normal saline for volume expansion when blood loss/hypovolemia is suspected (typical teaching dose 10 mL/kg when indicated).
• Umbilical venous catheter (UVC) supplies (or IO capability per protocol) because IV/UVC is the preferred epinephrine route; endotracheal epinephrine is a temporary bridge at best when access is delayed.
• Syringes, flush, antiseptic, ties/umbilical tape, and dosing references or pre-calculated sheets for estimated weights.

Putting the Check Together

A practical 30–60 second pass before a birth might sound like: “Warmer on, towels and hat ready, plastic wrap for 30 weeks. Suction at 100, bulb present. Stethoscope here. T-piece working, term and preterm masks, blender at starting FiO2, pulse ox and ECG open. Laryngoscope lights, ETT sizes 2.5–3.5, CO2 detector, size-1 LMA. Epi 0.1 mg/mL drawn plan, saline, UVC tray intact.” If any item fails the function test, fix it before delivery or escalate immediately.

Exam traps: adult defibrillator pads as “essential NRP gear,” adult-only bag-masks, leaving the warmer off to “save energy,” suction at unrestricted maximum pressure, and epinephrine at the wrong concentration.