Impact of the Neonatal Resuscitation Video Review program for neonatal staff: a qualitative analysis.

Background For paediatrics residents, much of newborn care is learned during Neonatal Intensive Care Unit (NICU) rotations. However, the NICU is a high-stress and specialized learning environment. Today’s residents often have less NICU exposure during their training than in the past, leading to concerns from trainees that they are inadequately prepared for neonatal care and resuscitation upon graduation. Objectives We aimed to develop, implement and evaluate a paediatric residency NICU curriculum aimed to augment and improve learning on rotation. Design/Methods We utilized Kern’s Six Step Approach for Curriculum Development. Step 1: We identified that our paediatric residents consistently expressed dissatisfaction with the quality and quantity of learning opportunities on their NICU rotations. Step 2: A collaborative working group of residents, paediatricians, and neonatologists identified learning needs. Step 3: Needs were mapped to specific general paediatrics educational objectives within the Royal College Competency Based Medical Education (CBME) curriculum. Step 4: Suitable learning strategies were selected including simulation, procedural skill training, embedded time with the neonatal resuscitation team, and lunch and learn seminars. Steps 5 and 6: The curriculum was piloted during the 2021-2022 academic year and resident reactions evaluated. Results The detailed curriculum is shown in Table 1. At the start of each NICU rotation, all paediatrics residents on rotation attended a half-day simulation based “boot-camp” consisting of a didactic Neonatal Resuscitation Program (NRP) refresher course, relevant procedural skills stations (intubation, UVC placement, needle thoracocentesis), and simulated neonatal resuscitation scenarios. Junior residents were scheduled for protected time to attend deliveries with a dedicated multidisciplinary resuscitation team to ensure familiarity and begin to solidify skills. Learning was further augmented by weekly, resident-led lunch and learn sessions on topics mapped to level of training. To evaluate this curriculum, resident satisfaction was assessed using surveys post bootcamp and at the end of their rotation. Overall, the curriculum was well received. Bootcamp was the highest rated element; 96% of residents agreed or strongly agreed that the session was useful for their education (Figure 1). Post curriculum implementation, there was significant improvement in resident NICU rotation feedback; residents expressed that the NICU learning environment and resident experience has improved. Conclusion We successfully implemented a NICU curriculum for paediatrics residents, with high satisfaction ratings and improved overall rotation feedback. This program shows promise in addressing a long standing educational gap. More research is needed to investigate whether it leads to improved competency in practice.

Reply

Wilderness First Responder: Are Skills Soon Forgotten?

Background and AimsPediatric house officers (HO) use neonatal resuscitation (NR) skills during their rotations in the neonatal intensive care unit (NICU). To improve HOs’ competence and retention of skills in...

BackgroundNeonatal mortality remains high in Ethiopia at 35/1000, despite improvements in reducing the overall child mortality. Through the RCPCH VSO Fellowship a Paediatric trainee was placed in Arba Minch Hospital,...

After completing this article, readers should be able to: 1. Define the indeterminate class of recommendations for neonatal resuscitation. 2. Describe the two areas of current investigation within the indeterminate class recommendations. 3. Describe the application of two techniques from other settings within the indeterminate class recommendations. 4. Describe the indeterminate class recommendation for which conflicting evidence is emerging. With the shift to evidence-based guidelines, the process of revising the scientific framework for neonatal resuscitation and the derivative educational efforts will become more predictable and accessible. Beginning with the International Guidelines 2000, an Indeterminate Class of recommendations appeared. These focused on areas of intense scientific research that may lead to clinically important therapies; technological developments widely adopted for use in other age groups that may find a role in neonatal resuscitation; or emerging evidence that conflicts substantially with previous data, resulting in a revision of recommendations to withdraw support of a particular therapeutic approach. The advent of changes in evidence-based guidelines carries the obligation to monitor the impact of such changes. Finally, entirely new questions and proposed guideline recommendations will be submitted to evidence evaluation in the future. Five Indeterminate Class recommendations appeared in the neonatal resuscitation portion of the International Guidelines 2000 (Table⇓ ). Cerebral hypothermia following hypoxic-ischemic insult and positive-pressure ventilation with room air represent proposals in the translational research phase, moving from animal and molecular models into clinical trials. The recommendations relating to adjunctive airway techniques, laryngeal mask airway and exhaled carbon dioxide detection, recognize the importance of these techniques in the older pediatric and adult populations, but acknowledge the significant limitations in their application to neonates. The statement regarding high-dose epinephrine reinforces the conflicting nature of evidence relating to this therapy, yet it acknowledges that available evidence is extrapolated largely from older age groups and falls short of supporting …

Special consideration in neonatal resuscitation

Identifying Depression in Neonatal Intensive Care Unit Parents: Then What?

Jordan is one of the earliest countries that took a very strict approach to contain COVID-19 pandemic by declaring a country lock down. Our neonatal intensive care unit is a level three 30 beds unit. The shortage of neonatal nurses, doctors, and of respiratory support devices are the major existing challenges. During COVID-19 pandemic, those two issues were magnified. This paper will shortly discuss the measures taken as a preparedness for COVID-19 Pandemic in our unit. Team development and work schedule: The medical knowledge about COVID-19 was foggy, however; teamwork is the only ev-ident thing. Our team included, the neonatologists, pediatric intensivist, pediatric pul-monologists, in addition to the infectious disease specialist. The team also included three of our senior residents, and the neonatal unit head nurse. To enhance communication, we created a WhatsApp group (Peds COVID -19). Among this group, unidentified Patients’ information, in addition to recent publications and sci-entific opinions, were shared. Meeting with the obstetric department was done to famil-iarize both teams with the measures taken on both sides. The neonatal care is provided by two neonatologists. The in-house care providers are the pediatric residents. Senior residents are well-trained on neonatal resuscitation, endotra-cheal intubation, and umbilical venous catheterization. During COVID-19 lock down, residents were split into separate teams. Neonatal team, the pediatric floor team, and the emergency room team, each team had their sleeping room and lounges. The consultants did rounds daily, the in-house team consisted of two senior residents, and a junior resident. they did a 24-hour shift every four days and are off duty for the next three days. Regarding the nursing staff schedule, their work schedule changed from an 8- hour shift to a 12- hour shifts schedule. The aim was to promote staff well-being, minimize the number of staff who could potentially be exposed to a COVID-19 case, and therefore will need to be quarantined. Visitation policy: Mothers could come at any time, but fathers could visit briefly. Parents were requested to wear gowns and face masks. We continued to encourage breast feeding, and we continued to receive expressed breast milk from mothers at home. Neonatal isolation area: A separate area was designated for isolating asymptomatic infants born to COVID-19 positive or suspected mothers, another area was designated for sick newborns, both areas were outside the current NICU. A separate nursing staff were assigned to take care of the isolated newborns. Infection control measures: The unit medical and nursing staff were instructed to stay home if feeling unwell, with fever or respiratory illness. They were also instructed to declare any contact with sick individuals. Wearing face mask and maintaining social distancing whenever possible, is a policy we adopted very early. When providing medical care to suspected cases, the staff were instructed to follow the hospital protocol. Management plan: After reviewing the available literature of COVID-19 infection a management flow chart was constructed to standardize the care. It contains the main steps and principles of management. It was circulated to all residents, the hospital administration, and to the hospital infection control unit (Table1). This chart is designed to help with the initiation of the care. The management process might vary according to the patient situation, in addition to the change of the current COVID-19 knowledge that will mandate a change in the implemented guidelines. Neonatal units should have an in-house policy that will guarantee standardization of care, better communication with different disciplines, and most importantly policies that could decrease the transmission risk of the corona virus among the staff and neonatal patients. Infection control measures, minimum staff on duty, and shorter contact time, are the most important items in such policies.

BackgroundThe role of effective interprofessional teamwork is especially vital in the Neonatal Intensive Care Unit (NICU) where infants facing emergency situations are admitted. Proper neonatal resuscitation, facilitated by comprehensive resuscitation training, can significantly decrease the mortality rates associated with neonatal asphyxia and respiratory failure. This study aimed to develop a simulation-based interprofessional education (IPE) programme for medical staff working in a nursery and NICU and to assess its effectiveness on teamwork, communication skills, clinical performance, clinical judgement, interprofessional attitudes, and education satisfaction.MethodsThrough a demand survey, neonatal resuscitation was selected as the theme, and an IPE team comprised of one doctor and two nurses was formed. The education programme consisted of three sessions lasting a total of 140 min: two simulation exercises and one theoretical education session. Data were collected from 18 nurses working in the nursery and NICU and 9 doctors working in the paediatrics department.ResultsA comparison of the metrics before and after applying simulation-based IPE programmes revealed teamwork (Z=-2.67, p = .008), communication skills (Z=-2.68, p = .007), clinical performance (Z=-2.52, p = .012), clinical judgement (Z=-4.52, p < .001), and interprofessional attitude (Z=-3.64, p < .001) to have significantly improved. Education satisfaction scores were 4.73 points on average out of a maximum of 5. The simulation-based IPE programme was effective in improving the teamwork, communication, and clinical performance of resuscitation teams, individual clinical judgement, and interprofessional attitude.ConclusionsSimulation-based IPE is effective for enhancing teamwork, team communication, clinical judgement skills, and clinical performance in neonatal resuscitation. This programme has the potential to contribute to the improvement of patient safety and the quality of neonatal care. Additional studies are needed to longitudinally examine the effects of the programme on patient safety and quality of neonatal care.

Neonatal resuscitation is a life-saving intervention for birth asphyxia, a leading cause of neonatal mortality. Worldwide, four million neonate deaths happen annually, and birth asphyxia accounts for one million deaths. Improving providers' neonatal resuscitation skills is critical for delivering quality care and for morbidity and mortality reduction. However, retention of these skills has been challenging in developing countries, including Ethiopia. Hence, this study aimed to assess neonatal resuscitation skills retention and associated factors among midwives and nurses in Eastern Ethiopia. An institution-based cross-sectional study was conducted using a pre-tested, structured, observational checklist. A total of 427 midwives and nurses were included from 28 public health facilities by cluster sampling and simple random sampling methods. Data were collected on facility type, availability of essential resuscitation equipment, socio-demographic characteristics of participants, current working unit, years of professional experience, whether a nurse or midwife received refresher training, and skills and knowledge related to neonatal resuscitation. Binary logistic regression was used to analyse the association between neonatal resuscitation skill retention and independent variables. About 11.2% of nurses and midwives were found to have retention of neonatal resuscitation skills. Being a midwife (AOR, 7.39 [95% CI: 2.25, 24.24]), ever performing neonatal resuscitation (AOR, 3.33 [95% CI: 1.09, 10.15]), bachelor sciences degree or above (AOR, 4.21 [95% CI: 1.60, 11.00]), and good knowledge of neonatal resuscitation (AOR, 3.31 [95% CI: 1.41, 7.73]) were significantly associated with skill retention of midwives and nurses. Basic neonatal resuscitation skills of midwives and nurses in Eastern Ethiopia are not well retained. This could increase the death of neonates due to asphyxia. Being a midwife, Bachelor Sciences degree or above educational status, ever performing neonatal resuscitation, and good knowledge were associated with skill retention. Providers should be encouraged to upgrade their educational level to build their skill retention and expose themselves to NR. Further, understanding factors affecting how midwives and nurses gain and retain skills using high-level methodology are essential.

Objective To investigate the value of Pituitrin in neonatal cardiopulmonary resuscitation. Methods Seventy-three cases with neonatal cardiopulmonary arrest admitted in emergency department and NICU in our hospital were collected during 2007 to 2011. Newborns who did not respond to conventional neonatal resuscitation therapy were divided into two groups: epinephrine group 47 cases (control group) and Pituitrin combined with epinephrine group 26 cases (treatment group). Results There were no statistical difference (χ2=0.956, P>0.05) between treatment group and control group in the rates of initial resuscitation success (23.1%, 6/26 vs 34.0%, 16/47). Conclusion Pituitrin combined with epinephrine has similar efficacy with the use of epinephrine in neonatal cardiopulmonary resuscitation. Key words: Epinephrine; Pituitrin; Cardiopulmonary resuscitation; Newborn

Underuse Versus Overuse of Neonatal Intensive Care: What Is the Right Amount?

The newborn care facilities, policies, and patient load in the perinatal care centers (PNCCs) in Saudi Arabia were assessed in 1985 as a first step toward providing data that would be needed in for...

Introduction: Anaesthetists are among several health care practitioners responsible for neonatal resuscitation in Canada. The Neonatal resuscitation program (NRP) courses are the North American educational standard. NRP has been shown to be an effective way of learning skills and knowledge but retention has been found to be problematic [1]. The use of cognitive aids is mandatory in industries such as aviation, to avoid dependence on memory when decision making in critical situations. Visual cognitive aids have been studied retrospectively in resuscitation and performance was found to correlate to the frequency of use of the aid [2]. Cognitive aids have been found to be of benefit in an unblinded prospective study [3]. We aimed to conduct the first blinded study on the effect of a cognitive aid on the performance of simulated resuscitation. Methods: We conducted a single-blind randomized controlled trial to investigate whether the presence of a cognitive aid improved performance in a simulated neonatal resuscitation. After ethics board approval we recruited 32 anaesthesia residents who had previously passed the NRP. Subjects were randomized to an intervention group that had a poster detailing the NRP algorithm and a control group without the poster. The cognitive aid was positioned so that it could not be seen on the video recordings of the simulation that was used to assess performance. The scenario was piloted to confirm adequate blinding. Both groups had their performance in a simulated neonatal resuscitation recorded and subsequently analyzed by a peer, an expert anaesthetist and an expert neonatologist, using a previously validated checklist. A further rater observed the scenario in real time to examine frequency of use of the cognitive aid. Results: The inter-rater reliability of the checklist was excellent with an intraclass correlation coefficient of 0.88. Consequently the mean of the scores assigned by all three raters was used for analysis. The median checklist score in the control group 18.2 [15.0–20.5 (10.7–25.3)] was not significantly different from that in the intervention group 20.3 [18.3–21.3 (15.0–24.3)] (P = 0.08). Retention of NRP skills and knowledge of was poor: when evaluated by the neonatologist none of the subjects correctly performed all life-saving interventions necessary to pass the checklist. Although only one subject in the intervention group did not use the aid at all, only 26.7% used the aid frequently and none used it extensively. Discussion: Retention of skills after NRP training was poor. Our study confirms previous findings of poor retention of skills after NRP training: Kaczorowski et al. investigated family medicine trainees and found that none of 44 residents that were retested 6–8 months after an NRP course would have passed the course due to errors in life-saving interventions [1]. Previous research has shown that the presence of a cognitive aid can improve performance in the simulated management of a rare, high stakes scenario: malignant hyperthermia [3]. Our negative findings contrast with this and another previous study [2]. A potential reason for this discrepancy is that the raters in the previous studies were not blinded to group allocation, nor were the rating scales used validated. The infrequent use of the cognitive aid may be the reason that it did not improve performance in. Further research is required to investigate whether cognitive aids can be useful if their use is incorporated into NRP training. Conclusion: A randomized single-blinded trial found that a cognitive aid did not improve performance at simulated resuscitation, in contrast to previous retrospective and unblended studies. Retention of skills and knowledge after resuscitation training remains an ongoing challenge for medical educators.