How to Become a NICU / Pediatric Respiratory Therapist

Role

What a NICU or PICU respiratory therapist does

A NICU respiratory therapist runs the breathing side of newborn intensive care: setting and weaning ventilators, managing CPAP and high-flow nasal cannula, attending high-risk deliveries, assisting with intubation and surfactant administration, drawing and reading blood gases, and running inhaled nitric oxide. A PICU therapist does the same work for older infants and children, where the case mix shifts toward pediatric ARDS, status asthmaticus, trauma and post-operative cardiac patients.

Job boards split the role across several titles. Neonatal respiratory therapist and NICU RT mean the same post. Pediatric respiratory therapist is wider and often covers floors, the emergency department and outpatient asthma care, not only intensive care. None of these titles is a credential in itself.

Path

The path in five steps

1. Finish an accredited respiratory therapy program

   Neonatal and pediatric respiratory therapist education starts in the same place as adult RT education: an entry-to-practice program accredited by CoARC (the Commission on Accreditation for Respiratory Care), at associate degree level or higher. There is no separate NICU degree. If you already know where you want to end up, pick a program whose clinical rotations include a level III or IV NICU and a PICU, because that is where you are most likely to see an infant on a high-frequency ventilator before your first job.

2. Earn the RRT

   The NPS sits on top of the RRT, so nothing else on this list moves until you hold it. In January 2027 NBRC replaces the TMC and CSE with a single Respiratory Therapy (RT) exam; its announcement says nothing about the NPS, which still requires the RRT (per NBRC, as of October 2026). If you test for the RRT before January 2027, you sit the current two exams; from then on, the single RT exam. Either way the NPS rule is the same: you must already hold the RRT credential.

3. Get onto a neonatal or pediatric unit

   Employers decide who staffs their NICU and PICU, and their hiring rules vary. Some children's hospitals take new graduates into a training track; many adult-and-pediatric hospitals rotate staff RTs through the NICU after orientation. Postings for these units often ask for NRP and PALS cards. That is employer policy, so read each posting rather than assuming.

4. Pass the NPS

   170 multiple-choice items in 4 hours, split into two content sections. NBRC sets no minimum months of neonatal work, but the exam is written for someone who has done the job: most scored items test application or analysis, not recall. Format, scoring and retakes are on the NPS exam page.

5. Keep the credential

   Each RRT-NPS carries a five-year credential term and is maintained through NBRC's Credential Maintenance Program (details below). Miss it and the specialty lapses, even while you keep working the same unit.

Exp

What the exam expects you to have seen

The NPS outline reads like a NICU and PICU job description. Section I, shared care, holds 80 of the 150 scored items; Section II, critical care, holds 70 of the 150 scored items, and ventilation and oxygenation (II-C) alone is 30 of them. Experience matters because the analysis items hand you a patient, a blood gas and the current settings and ask what changes next. That is hard to fake from a textbook.

The outline also sets a floor of items per patient type in its item pool, and at least 86 pulmonary items on every form. Neonatal pulmonary problems and asthma lead the list, which is the clearest sign of the case mix you should have worked with before you sit the exam.

NPS

The NPS step on one sheet

The exam follows the Detailed Content Outline effective October 1, 2025. Every form carries 20 unscored pretest items, which you cannot tell apart from the scored ones, so pace for all 170.

Sources: NBRC Candidate Handbook (Sept 2026), NBRC NPS exam page. Checked October 2026.

Before you book, run the 60-row NPS practice test: it splits the two sections like the real form and shows which one you are weaker in.

CV

What “neonatal/pediatric specialist” means on a résumé

Neonatal/pediatric specialist is the second half of RRT-NPS (Registered Respiratory Therapist, Neonatal/Pediatric Specialist). On a résumé it tells a hiring manager that you have passed a national exam on neonatal and pediatric care, beyond the general RRT. It is a voluntary specialty credential, not a state license, so your state license still rests on the credential your state asks for.

Some NICU and PICU postings list the NPS as preferred, and some employers set it as a goal for a clinical ladder or a lead role. Those are hiring and promotion policies of a given employer, not a law, and they vary from one hospital to the next. CRT-NPS is a legacy designation still held by earlier CRT passers; a new candidate can only earn RRT-NPS.

RRT-NPS next to the other credentials on a posting

NRP and PALS are course completions, not board credentials; employers usually ask for them separately from the NPS.

CMP

Keeping the credential: CMP

You keep RRT-NPS through the Credential Maintenance Program: quarterly online assessments plus up to 30 CRCE over five years, or passing the exam again in the last year, or earning a new NBRC credential (per NBRC, as of October 2026). The credential carries a five-year credential term, so put the end date in your calendar the day you pass. NBRC's own page has the current rules: NBRC CMP answers.

FAQ

Questions people ask