Abstract
We wanted to assess newborn life support (NLS) knowledge and guideline adherence, and provide strategies to improve (neonatal) resuscitation guideline adherence. Pediatricians completed 17 multiple-choice questions (MCQ). They performed a simulated NLS scenario, using a high-fidelity manikin. The literature was systematically searched for publications regarding guideline adherence. Forty-six pediatricians participated: 45 completed the MCQ, 34 performed the scenario. Seventy-one percent (median, IQR 56–82) of the MCQ were answered correctly. Fifty-six percent performed inflation breaths ≤ 60 s, 24% delivered inflation breaths of 2–3 s, and 85% used adequate inspiratory pressures. Airway patency was ensured 83% (IQR 76–92) of the time. Median events/min, compression rate, and percentage of effective compressions were 138/min (IQR 130–145), 120/min (IQR 114–120), and 38% (IQR 24–48), respectively. Other adherence percentages were temperature management 50%, auscultation of initial heart rate 100%, pulse oximeter use 94%, oxygen increase 74%, and correct epinephrine dose 82%. Ten publications were identified and used for our framework. The framework may inspire clinicians, educators, researchers, and guideline developers in their attempt to improve resuscitation guideline adherence. It contains many feasible strategies to enhance professionals’ knowledge, skills, self-efficacy, and team performance, as well as recommendations regarding equipment, environment, and guideline development/dissemination.Conclusion: NLS guideline adherence among pediatricians needs improvement. Our framework is meant to promote resuscitation guideline adherence.What is Known:• Inadequate newborn life support (NLS) may contribute to (long-term) pulmonary and cerebral damage.• Video-based assessment of neonatal resuscitations has shown that deviations from the NLS guideline occur frequently; this assessment method has its audiovisual shortcomings.What is New:• The resuscitation quality metrics provided by our high-fidelity manikin suggest that the adherence of Dutch general pediatricians to the NLS guideline is suboptimal.• We constructed a comprehensive framework, containing multiple strategies to improve (neonatal) resuscitation guideline adherence.
Highlights
5–10% of all newborns require support of transition to initiate breathing and aerate the lungs; true resuscitation at birth, including chest compressions and medications, occurs significantly less often [1,2,3,4,5,6,7]
By attending the Newborn Life Support (NLS) and/or European Pediatric Advanced Life Support (EPALS) courses of the European Resuscitation Council (ERC), or the Neonatal Resuscitation Program (NRP) outside Europe, professionals can acquire and maintain the knowledge and skills required for guideline adherence
The only changes in the 2015 ERC guideline relevant to this study were (1) the more explicit recommendation to apply a higher peak inspiratory pressure (PIP) (i.e., 30 cm H2O) during inflation breaths in term newborns, (2) the gestational age below which plastic wrapping is indicated (< 32 weeks instead of < 28 weeks), and (3) the option to start with 30% oxygen in preterm infants [8]
Summary
NLS guideline adherence among pediatricians needs improvement. Our framework is meant to promote resuscitation guideline adherence. What is Known: Inadequate newborn life support (NLS) may contribute to (long-term) pulmonary and cerebral damage. Video-based assessment of neonatal resuscitations has shown that deviations from the NLS guideline occur frequently; this assessment method has its audiovisual shortcomings. What is New: The resuscitation quality metrics provided by our high-fidelity manikin suggest that the adherence of Dutch general pediatricians to the NLS guideline is suboptimal. We constructed a comprehensive framework, containing multiple strategies to improve (neonatal) resuscitation guideline adherence.
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