Neonatal Resuscitation Knowledge Research Articles

Knowledge and Practices of Neonatal Resuscitation by Health Providers in Côte d’Ivoire

Cote d’Ivoire ranks third among African countries with the highest neonatal mortality rate (38‰). Perinatal asphyxia is one of the major causes of neonatal mortality. In its severe form, it imposes an efficient neonatal resuscitation in the birth room. This can only be done when the proven competence of the staff in charge of the newborn and the availability of the appropriate equipment are met. What is the situation in the birth facilities of these two challenges for the response to the high rate of neonatal mortality in Cote d’Ivoire? Method: It is a cross-sectional study, which took place from March 28 to July 28, 2016, in three health districts of Cote d’Ivoire (Bouaké, Gagnoa, Yopougon). Public health structures offering delivery activities were selected. Based on a fact sheet, the practitioners present have been interviewed and a direct observation of the organization and equipment set up to perform neonatal resuscitation in the birth room has been done. In addition, an observation grid made it possible to evaluate the practical skills of providers in neonatal resuscitation on a newborn mannequin. The data were entered using the Epi-Info 7 software. Based on the data collected, we determined the numbers and frequencies of the responses of the target agents of the survey. Results: The membership structures included 46 first contact health facilities (FCHFs) and 4 reference hospitals (HRs). The heating system, mucus suction, oxygen, timers and self-inflating balloons were available in HR and in six, eight, four, 34 and 10 FCHFs respectively. The 253 midwives surveyed came from Bouaké (86), Gagnoa (62) and Yopougon (105). They had a seniority of at least eight years. Their knowledge for newborns’ care was acquired in initial training (75% of cases). They knew the golden minute in 95.6% of the cases. Inadequacies in the recognition of risk situations, useful equipment and in the execution of neonatal resuscitation steps were noted. Conclusion: The survival of the newborn is still very worrying in Cote d’Ivoire. An analysis of the results of this survey shows that many challenges remain not only at the structural level but also at the level of quality of care.

Helping Babies Breathe (HBB) training: What happens to knowledge and skills over time?

BackgroundThe first minutes after birth are critical to reducing neonatal mortality. Helping Babies Breathe (HBB) is a simulation-based neonatal resuscitation program for low resource settings. We studied the impact of initial HBB training followed by refresher training on the knowledge and skills of the birth attendants in facilities.MethodsWe conducted HBB trainings in 71 facilities in the NICHD Global Network research sites (Nagpur and Belgaum, India and Eldoret, Kenya), with a 6:1 ratio of facility trainees to Master Trainers (MT). Because of staff turnover, some birth attendants (BA) were trained as they joined the delivery room staff, after the initial training was completed (catch-up initial training). We compared pass rates for skills and knowledge pre- and post- initial HBB training and following refresher training among active BAs. An Objective Structured Clinical Examination (OSCE) B tested resuscitation skill retention by comparing post-initial training performance with pre-refresher training performance. We identified factors associated with loss of skills in pre-refresher training performance using multivariable logistic regression analysis. Daily bag and mask ventilation practice, equipment checks and supportive supervision were stressed as part of training.ResultsOne hundred five MT (1.6 MT per facility) conducted initial and refresher HBB trainings for 835 BAs; 76% had no prior resuscitation training. Initial training improved knowledge and skills: the pass percentage for knowledge tests improved from 74 to 99% (p < 0.001). Only 5% could ventilate a newborn mannequin correctly before initial training but 97% passed the post-initial ventilation training test (p < 0.0001) and 99% passed the OSCE B resuscitation evaluation. During pre-refresher training evaluation, a mean of 6.7 (SD 2.49) months after the initial training, 99% passed the knowledge test, but the successful completion rate fell to 81% for the OSCE B resuscitation skills test. Characteristics associated with deterioration of resuscitation skills were BAs from tertiary care facilities, no prior resuscitation training, and the timing of training (initial vs. catch-up training).ConclusionsHBB training significantly improved neonatal resuscitation knowledge and skills. However, skills declined more than knowledge over time. Ongoing skills practice and monitoring, more frequent retesting, and refresher trainings are needed to maintain neonatal resuscitation skills.Trial registrationClinicalTrials.gov Identifier: NCT01681017; 04 September 2012, retrospectively registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1141-3) contains supplementary material, which is available to authorized users.

New HybridLab Training Method of Clinical Skills Learning in Neonatology: Students’ Opinion

This article was migrated. The article was not marked as recommended. Background: To improve the training process and its results, we used a novel method of studies of medicine in a hybrid laboratory (HybridLab). The aim of the HybridLab training method is to develop standardized practical skills and to improve long-term memory. We created a peer-teaching model that included e-learning modules combined with online checklist-driven skills and decision flowcharts that started with simple steps and progressively worked towards complex simulation scenarios. The aim of this study was to evaluate students' opinion about initial neonatal resuscitation (INR) training by applying the HybridLab method. Methods: We analyzed how fifth-year medical students of the Lithuanian University of Health Sciences (LUHS) Medical Academy evaluated their initial neonatal resuscitation (INR) knowledge before and after the training cycle by using a standardized evaluation questionnaire (a 7-point Likert scale), and conducted a qualitative study using the in-depth unstructured interview technique. Results: The mean evaluation of INR knowledge before the training cycle was 3.19±1.92 points, and after the cycle - 6.84±0.44 points. The overall score of the evaluation of the respondents' knowledge increased by 3.77±1.9 points (p&lt;0.001). In total, 34.6 % of the respondents presented positive evaluations of the HybridLab method, whereas 15.4 % of the respondents presented negative evaluations. Neutral opinions were presented by 19.7 % of the respondents, and 19.7 % of the students did not have an opinion. Conclusions: The HybridLab training method may increase students' satisfaction with the training process, may improve their self-confidence, and may ensure the quality of the acquisition of practical skills.

Association Between the Safe Delivery App and Quality of Care and Perinatal Survival in Ethiopia: A Randomized Clinical Trial.

Health apps in low-income countries are emerging tools with the potential to improve quality of health care services, but few apps undergo rigorous scientific evaluation. To determine the effects of the safe delivery app (SDA) on perinatal survival and on health care workers' knowledge and skills in neonatal resuscitation. In a cluster-randomized clinical trial in 5 rural districts of Ethiopia, 73 health care facilities were randomized to the mobile phone intervention or to standard care (control). From September 1, 2013, to February 1, 2015, 3601 women in active labor were included at admission and followed up until 7 days after delivery to record perinatal mortality. Knowledge and skills in neonatal resuscitation were assessed at baseline and at 6 and 12 months after the intervention among 176 health care workers at the included facilities. Analyses were performed based on the intention-to-treat principle. Health care workers in intervention facilities received a smartphone with the SDA. The SDA is a training tool in emergency obstetric and neonatal care that uses visual guidance in animated videos with clinical instructions for management. The primary outcome was perinatal death. Secondary outcomes included the knowledge and clinical management of neonatal resuscitation (skills) of health care workers before the intervention and after 6 and 12 months. The analysis included 3601 women and 176 health care workers. Use of the SDA was associated with a nonsignificant lower perinatal mortality of 14 per 1000 births in intervention clusters compared with 23 per 1000 births in control clusters (odds ratio, 0.76; 95% CI, 0.32-1.81). The skill scores of intervention health care workers increased significantly compared with those of controls at 6 months (mean difference, 6.04; 95% CI, 4.26-7.82) and 12 months (mean difference, 8.79; 95% CI, 7.14-10.45) from baseline, corresponding to 80% and 107%, respectively, above the control level. Knowledge scores also significantly improved in the intervention compared with the control group at 6 months (mean difference, 1.67; 95% CI, 1.02-2.32) and at 12 months (mean difference, 1.54; 95% CI, 0.98-2.09), corresponding to 39% and 38%, respectively, above the control level. The SDA was an effective method to improve and sustain the health care workers' knowledge and skills in neonatal resuscitation as long as 12 months after introduction. Perinatal mortality was nonsignificantly reduced after the intervention. The results are highly relevant in low-income countries, where quality of care is challenged by a lack of continuing education. clinicaltrials.gov Identifier: NCT01945931.

Intervention Improved Health Workers’ Neonatal Resuscitation Skills and Knowledge, but Not Neonatal Mortality

Health care workers who participated in a mobile phone-based safe delivery intervention had greater skills and knowledge regarding neonatal resuscitation than control workers, according to a cluster-randomized clinical trial conducted at 70 health care facilities in rural Ethiopia. (1) Neonatal resuscitation skills scores six months and 12 months after implementation of the safe delivery app intervention were higher among intervention health care workers than among controls (mean differences, 6.0 and 8.8 points, respectively); neonatal resuscitation knowledge was higher among intervention health care workers than among controls at six months postimplementation (mean difference, 1.7 points), but not at 12 months. The intervention was not associated with a significant change in perinatal mortality of infants delivered at study health care facilities. The safe delivery app was designed to provide health care workers in low-income countries with the knowledge and skills to manage obstetric and neonatal emergencies; the app consisted of videos on topics such as neonatal resuscitation, as well as a catalog of essential obstetric drugs and equipment. To examine whether use of the app was associated with changes in perinatal mortality rates and in health care workers' knowledge and skill levels, researchers conducted a cluster-randomized clinical trial of health care facilities in five rural districts of Ethiopia's Oromiya region. Of the 131 facilities that were screened, 70 met the study's eligibility criteria (i.e., having a midwife or health extension worker on staff and having been the site of deliveries in the previous year) and were included in the study sample. Half of eligible facilities were randomly selected to the intervention group and were supplied with smartphones loaded with the safe delivery app; health care workers at intervention facilities received a one-day training session on how to use the phones and app. The other half of facilities were selected to the control group, and did not receive phones or additional training; the researchers ensured that both intervention and control facilities had an adequate package of drugs and equipment. Between September 2013 and February 2015, data were collected on women delivering at study facilities and on their birth outcomes; women were contacted in person or by phone seven days after delivery to follow up about perinatal mortality. In addition, facility health care workers' knowledge and skills regarding neonatal resuscitation were assessed by questionnaire and structured assessment tools (e.g., simulated scenarios using mannequins) before implementation of the intervention and at six and 12 months afterward. Descriptive and logistic regression analyses were used to compare perinatal mortality rates at intervention and control facilities, and to compare health care workers' neonatal resuscitation knowledge and skills index scores over time. The analysis sample included 1,474 women in the intervention group and 1,665 in the control group. Most women in each group (>85%) reported being younger than 29, having a primary or lower education and being a housewife; more than one-third of women in each group were pregnant for the first time. …

Development and evaluation of a simulation exercise to prepare midwifery students for neonatal resuscitation

Simulation provides opportunities for midwifery students to enhance their performance in emergency situations. Neonatal resuscitation is one such emergency and its management is a major concern for midwifery students. This project aimed to develop and evaluate a simulation exercise, for neonatal resuscitation, for 3rd year midwifery students. A quantitative survey design was employed using questions from two previously validated questionnaires: (1.) Student Satisfaction and Self-Confidence in Learning and (2.) the Clinical Teamwork Scale (CTS). Australian university. 40 final year midwifery students were invited to participate and 36 agreed to take part in the project. In pre-simulation questionnaires, students reported low levels of confidence in initiating care of an infant requiring resuscitation. Most anticipated that the simulation exercise would be useful to better prepare them respond to a neonatal emergency. Post-simulation questionnaires reported an increase in student confidence, with 30 of 36 students agreeing/ strongly agreeing that their confidence levels had improved. Nonetheless, an unexpected number of students reported a lack of familiarity with the equipment. The single simulation exercise evaluated in this project resulted in improved student confidence and greater knowledge and skills in neonatal resuscitation. However, deficits in handling emergency equipment, and in understanding the role of the student midwife/midwife in neonatal resuscitation, were also noted. For the future, the development and evaluation of a programme of simulation exercises, over a longer period, is warranted. This approach may reduce stress and better address student learning needs.

Educational outcomes of Helping Babies Breathe training at a community hospital in Honduras.

ObjectivesHelping Babies Breathe is an evidence-based curriculum designed to teach basic neonatal resuscitation in low-resource countries. The purpose of this study was to evaluate the acquisition of knowledge and skills following this training and correlation of learner characteristics to performance in a Spanish-speaking setting.MethodsThirty-one physicians and 39 nurses completed Helping Babies Breathe training at a Honduran community hospital. Trainee knowledge and skills were evaluated before and after the training using a multiple-choice questionnaire, bag-mask ventilation skills test, and two objective structured clinical exams (OSCEs). Linear mixed-effects models were used to analyze assessment scores pre- and post-training by profession (physician or nurse) while controlling for covariates.ResultsHelping Babies Breathe training resulted in significant increases in mean scores for the multiple-choice question test, bag-mask ventilation skills test, and OSCE B. Time to initiation of effective bag-mask ventilation decreased from a mean of 74.8 to 68.4 s. Despite this improvement in bag-mask ventilation, only 42 % of participants were able to initiate effective bag-mask ventilation within the Golden Minute. Although physicians scored higher on the pre-test multiple-choice questions and bag-mask ventilation, nurses demonstrated a greater mean difference in scores after training. OSCE B scores pre- and post-training increased similarly between professions. Nurses’ and physicians’ performance in simulation was not significantly different after the training. Assessment scores and course feedback indicated a need for more skills practice, particularly with bag-mask ventilation.ConclusionsWhen evaluated immediately after an initial workshop, Helping Babies Breathe training resulted in significant gains in neonatal resuscitation knowledge and skills. Following training, nurses, who commonly do not perform these skills in real-life situations, were able to perform at a similar level to physicians. Further studies are necessary to determine how to sustain this knowledge and skills over time, tailor the course to learner characteristics, and whether this training translates into improvements in clinical practice.

Team training in obstetric and neonatal emergencies using highly realistic simulation in Mexico: impact on process indicators

BackgroundIneffective management of obstetric emergencies contributes significantly to maternal and neonatal morbidity and mortality in Mexico. PRONTO (Programa de Rescate Obstétrico y Neonatal: Tratamiento Óptimo y Oportuno) is a highly-realistic, low-tech simulation-based obstetric and neonatal emergency training program. A pair-matched hospital-based controlled implementation trial was undertaken in three states in Mexico, with pre/post measurement of process indicators at intervention hospitals. This report assesses the impact of PRONTO simulation training on process indicators from the pre/post study design for process indicators.MethodsData was collected in twelve intervention facilities on process indicators, including pre/post changes in knowledge and self-efficacy of obstetric emergencies and neonatal resuscitation, achievement of strategic planning goals established during training and changes in teamwork scores. Authors performed a longitudinal fixed-effects linear regression model to estimate changes in knowledge and self-efficacy and logistic regression to assess goal achievement.ResultsA total of 450 professionals in interprofessional teams were trained. Significant increases in knowledge and self-efficacy were noted for both physicians and nurses (p <0.001- 0.009) in all domains. Teamwork scores improved and were maintained over a three month period. A mean of 58.8% strategic planning goals per team in each hospital were achieved. There was no association between high goal achievement and knowledge, self-efficacy, proportion of doctors or nurses in training, state, or teamwork score.ConclusionsThese results suggest that PRONTO’s highly realistic, locally appropriate simulation and team training in maternal and neonatal emergency care may be a promising avenue for optimizing emergency response and improving quality of facility-based obstetric and neonatal care in resource-limited settings.Trial registrationNCT01477554

The Effectiveness of E-Learning in Enhancing Neonatal Resuscitation Skills, Knowledge and Confidence of Undergraduate Nursing Students

Background: In recent decades, the use of information and communication technologies (ICT) for educational purposes has increased, and the spread of network technologies has caused e-learning practices to evolve significantly. E-learning is used increasingly in healthcare professionals' education. In higher education, audio and video productions prove effective in enhancing student-learning outcomes and increase student satisfaction. Aim of the study: The purpose of the study is to investigate the effectiveness of e-learning in enhancing neonatal resuscitation skills, knowledge and confidence of undergraduate nursing students. Material and methods: Forty undergraduate students who registered for Pediatric course from College of Nursing-Jeddah were recruited for the study. A single-blind Randomized Control Trial design was used. Nursing students of the control group allocated to the tradition method of demonstration and re-demonstration of neonatal resuscitation skills in nursing lab while the nursing students of the experimental have access to video about neonatal resuscitation in addition to the tradition method. Results: The results of the current study revealed that the nursing students of the experimental group were more skillful and had more knowledge about neonatal resuscitation than the nursing students of the control group and the differences were not statistically significant. Moreover, it was found that the nursing students of the control group reported higher level of self-confidence than nursing students of the experimental group and the difference was not statistically significant. Conclusion and recommendation: The results of current study revealed improvement in nursing students’ skills, knowledge about neonatal resuscitation but the differences was not statistically significant. Further researches are necessary with increasing the number of students and video-viewing frequency may affect the learning outcomes.

Helping babies breathe: Providing an evidence-based education intervention at a tertiary referral hospital in Liberia

Background: Helping Babies Breathe (HBB) is a neonatal resuscitation program that utilizes an active learning pedagogy to increase knowledge and skills for nurses and midwives in resource-limited areas. Two faculty members from the Tubman National Institute of Medical Arts in Liberia became certified as HBB trainers while completing a graduate nurse educator degree in the US. The aim of the current study was to use an academic program requirement for a graduate practicum and research experience to determine the effect of implementing the HBB program on the level of neonatal resuscitation knowledge and skills of students and staff at the John F. Kennedy Medical Center (JFKMC) in Liberia. Methods: The HBB program was provided to 154 participants from the JFKMC and the co-located Tubman National Institute of Medical Arts for a period of six weeks. Assessment of the participants’ neonatal resuscitation skills and knowledge included pre/post scores on multiple choice questions and evaluation of the bag and mask ventilation skills using an objective structured clinical examination (OSCE) approach. Results: Participants expressed satisfaction with the program and the skills acquired. A paired t test for the multiple choice items indicated significant knowledge difference between the pretest (2.36 ± 2.21) and posttest (15.27 ± 1.24) scores, p = .000. On the skills checklist for OSCE A, all participants achieved final competency rates of 100% on six items, 90%- 99% on two, 70%-79% on one, and <69% on four items; on OSCE B, they achieved final competency rates of 100% on 12 checklist items, 90%-99% on one, 80%-89% on three, 70%-79% on one, and <69% on one item. Conclusions: Implementing the HBB training is an important initial step in providing delivery room staff with the skills and knowledge to reduce neonatal mortality from asphyxia. The training needs to be supplemented with additional, ongoing practice and institutional support. The model of allowing internationally educated nurses completing graduate nurse educator degrees in the US to complete practicum and research requirements at their home institution was successful. Nurse and midwifery faculty who are certified in providing the HBB can effectively provide this training. We recommend that HBB training be provided in all health care facilities in developing countries with high neonatal mortality rates.

G313(P) Establishing a Neonatal Unit in Arba Minch Hospital, Ethiopia

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,...

Simulation-based training in neonatal resuscitation program for residents

Objective To examine the effectiveness of simulation newborn simulator in neona-tal resuscitation training for pediatric residents. Methods From June 2011 to June 2012, 11 residents working in neonatal ward of the Third Hospital of Peking University were enrolled into the study. Eval-uation on the residents was made before the training. Training of simulated teaching using simulation newborn simulator was conducted and evaluation was made after the training. SPSS 18.0 was used for statistical analysis. Comparison was made between pre- and post-training test by paired t test. P〈0.05 was considered statistical significant. Questionnaire survey was conduct to acquire residents＇ feedback. Results A total of 11 participants completed the training and finished the questionnaire. The score of pre-training was 37.82±1.17 versus that of post-training 39.18±0.87（t=4.89, P〈0.01）. All residents were satisfied with the simulation-based training. Conclusion Simulation training can improve pedi-atric residents＇ knowledge and skills in neonatal resuscitation. Key words: Simulation-based training; Neonatal resuscitation program; Newborn simulator

A study on knowledge and practice of neonatal resuscitation among nursing staff

Birth asphyxia is a major cause of global neonatal death. One of the effective measures to prevent these deaths is to have skilled birth attendants in neonatal resuscitation. Several trials have shown that basic neonatal training can decrease neonatal deaths. My study is a cross-sectional observational study to determine the knowledge and practice about neonatal resuscitation among nursing staff working in up to secondary level care. ( Key words: neonatal resuscitation; birth asphyxia) Sri Lanka Journal of Child Health , 2014; 43 (1): 38-40 DOI: http://dx.doi.org/10.4038/sljch.v43i1.6660

Knowledge and skills of neonatal resuscitation of health professionals at a university teaching hospital of Northwest Ethiopia.

Competency in neonatal resuscitation is critical in the delivery rooms, neonatology units and pediatrics intensive care units to ensure the safety and health of neonates. Each year, millions of babies do not breathe immediately at birth, and among them the majority require basic neonatal resuscitation. Perinatal asphyxia is a major contributor to neonatal deaths worldwide in resource-limited settings. Neonatal resuscitation is effective only when health professionals have sufficient knowledge and skills. But malpractices by health professionals are frequent in the resuscitation of neonates. The present study was to assess the knowledge and skills of health professionals about neonatal resuscitation. An institution based cross-sectional study was conducted in our hospital from February15 to April 30, 2014. All nurses, midwives and residents from obstetrics-gynecology (obs-gyn), midwifery and pediatric departments were included. The mean scores of knowledge and skills were compared for sex, age, type of profession, qualification, year of service and previous place of work of the participants by using Student's t test and ANOVA with Scheffe's test. A P value <0.05 was considered statistically significant. One hundred and thirty-five of 150 participants were included in this study with a response rate of 90.0%. The overall mean scores of knowledge and skills of midwives, nurses and residents were 19.9 (SD=3.1) and 6.8 (SD=3.9) respectively. The mean knowledge scores of midwives, nurses, pediatric residents and obs-gyn residents were 19.7 (SD=3.03), 20.2 (SD=2.94), 19.7 (SD=4.4) and 19.6 (SD=3.3) respectively. Whereas the mean scores of skills of midwives, nurses, pediatric residents and obs-gyn residents were 7.1 (SD=4.17), 6.7 (SD=3.75), 5.7 (SD=4.17) and 6.6 (SD=3.97) respectively. The knowledge and skills of midwives, nurses and residents about neonatal resuscitation were substandardized. Training of neonatal resuscitation for midwives, nurses and residents should be emphasized.

Adrenaline in neonatal resuscitation: are there knowledge gaps?

Despite the widespread use of adrenaline in adult cardiopulmonary resuscitation, the main concern in using this drug in neonates is the lack of evidence. At present, there are very few reliable human and animal data to justify the use of adrenaline in neonatal resuscitation and significant knowledge gaps exist, which necessitate further research. Proceedings of the 9 th International Workshop on Neonatology · Cagliari (Italy) · October 23 rd -26 th , 2013 · Learned lessons, changing practice and cutting-edge research

Wiedza personelu ratownictwa medycznego na temat resuscytacji noworodka

Immediately after birth, approximately 10% of newborns need interventions to facilitate lung recruitment and begin spontaneous respiration. A full resuscitation procedure is required by < 1% of newborns. Because you can't always predict the need to perform CPR, at every birth someone trained to conduct such operations should be in attendance. The aim of this study was to investigate the understanding of neonatal resuscitation at birth among emergency medical personnel. This study was conducted in 2012 among a group of 270 people (doctors, nurses and paramedics) working in teams of emergency medical services in Poland. The study involved the issue of a questionnaire, checking knowledge of neonatal resuscitation. Results. 79% of respondents knew the time limits for the use of the term 'newborn'. All respondents had knowledge of the order of proceedings in CPR (76-100%) and the ratio of compressions to ventilation during neonatal resuscitation (76-100%). The group of nurses, compared to doctors and paramedics, knew very little about the following topics: energy shock (44% vs. 100% vs. 100%), tidal volume (24% vs. 92% vs. 78%), and the dose of sodium bicarbonate (32% vs. 96% vs. 87%). The best prepared professional groups regarding newborn resuscitation are doctors and paramedics. The incomplete knowledge found in nurses should lead to intensified training in this occupational group.

'Helping Babies Breathe' Training in Sub-Saharan Africa: Educational Impact and Learner Impressions

Poor resuscitation contributes significantly to neonatal deaths globally. Helping Babies Breathe (HBB) is a new evidence-based neonatal resuscitation curriculum for low-resource settings. We sought to characterize knowledge changes after national-level HBB training in Ethiopia, factors correlated with successful training, resuscitation skills and trainees' perceptions. Trainees completed multiple-choice questionnaires (MCQ) before and after a 2-day course. After training, bag-mask ventilation (BMV) skills were assessed and feedback questionnaires completed. Resuscitation knowledge improved from 8.7/10 (SD 1.4) to 9.4/10 (SD 1.1; p = 0.003). Correct MCQ responses relating to essential aspects of resuscitation increased 68-79%. Pre-training knowledge differences between physicians and non-physicians disappeared. MCQ scores increased as trainer:trainee ratio decreased (p = 0.004). Mean post-HBB BMV scores [5.7/7 (SD 1.6)] were not impacted by trainer:trainee ratio. Ethiopian HBB training improved neonatal resuscitation knowledge and was well received. Lower trainer:trainee ratio was associated with increased MCQ scores. HBB eliminated baseline knowledge differences between Ethiopian healthworker cadres.

Educational impact of a hospital-based neonatal resuscitation program in Ghana

Aim of the study To assess midwives’ baseline cognitive knowledge of evidence-based neonatal resuscitation practices, and short- and long-term educational effects of teaching a neonatal resuscitation program in a hospital setting in West Africa. Methods All midwives ( n = 14) on the labor ward at Ridge Hospital in Ghana were trained using materials modified from the American Academy of Pediatrics (AAP) Neonatal Resuscitation Program (NRP). This training program included didactic and practical teaching and was assessed by direct observation within delivery rooms and written pre- and post-test evaluations. Written and practical modules 9–12 months after the initial training session were also conducted to assess retention of NRP knowledge and skills. Results Fourteen midwives received NRP training on the labor ward. Both written and practical evaluation of neonatal resuscitation skills increased after training. The percentage of items answered correctly on the written examination increased from 56% pre-training to 71% post-training ( p < 0.01). The percentage of items performed correctly on the practical evaluation of skills increased from 58% pre-training to 81% ( p < 0.01). These results were sustained 9–12 months after the initial training session. Conclusion After receiving NRP training, neonatal resuscitation knowledge and skills increased among midwives in a hospital in West Africa and were sustained over a 9-month period. This finding demonstrates the sustained effectiveness of a modified neonatal resuscitation training program in a resource constrained setting.

Tele-education vs classroom training of neonatal resuscitation: a randomized trial

To compare gain in knowledge and skills of neonatal resuscitation using tele-education instruction vs conventional classroom teaching. This randomized controlled trial was conducted in the tele-education facility of a tertiary care center. In-service staff nurses were randomized to receive training by tele-education instruction (TI, n=26) or classroom teaching (CT, n=22) method from two neonatology instructors using a standardized teaching module on neonatal resuscitation. Gain in knowledge and skill scores of neonatal resuscitation were measured using objective assessment methods. Age, educational qualification and professional experience of the participants in two groups were comparable. Pre-training mean knowledge scores were higher in TI group (8.3±1.7 vs 6.6±1.4, P=0.004). However, skill scores were comparable in the two groups (11.7±3 vs 10.3±2.9, P=0.13). Training resulted in a significant and comparable gain in knowledge scores (4.2±2.2 vs 5.3±1.7; P=0.06) and skills scores (4.5±3.3 vs 5.0±3.1, P=0.62) in both the groups. The post-training knowledge scores (TI: 12.5±1.7 vs CT: 12.0±1.7, P=0.37) and the post-training skill scores (TI: 16.0±0.5 vs CT: 15.6±2.5, P=0.55) were comparable in the two groups. However, the post-training scores, adjusted for baseline knowledge scores, were statistically higher in the in-person group compared with the telemedicine group (knowledge: 12.46±0.03 vs 12.16±0.01, P=0.00; skills: 15.6±2.5 vs 16.0±2.8, P=0.00). The quantum of lower scores in the telemedicine group was only 2% for knowledge and 6% for skills. This difference was felt to be of only marginal importance. Satisfaction scores among trainees and instructors were comparable in the two groups. Tele-education offers a feasible and effective alternative to conventional training in neonatal resuscitation among health-care providers.

High-fidelity simulation in neonatal resuscitation

There are currently few studies describing the use of high-fidelity (hi-fi) simulation in teaching neonatal resuscitation. Traditionally, residents are certified in the neonatal resuscitation program (NRP) after successful completion of a multiple-choice written examination and demonstration of skills during a hands-on 'mega-code'. In the present study, the use of a hi-fi simulation mannequin was compared with a standard plastic mannequin when teaching the megacode portion of the NRP. In the present pilot study, 15 first-year residents were randomly assigned to demonstrate neonatal resuscitation knowledge, with either the hi-fi mannequin (SimBaby, Laerdal Medical Corporation, USA) or a traditional plastic mannequin (ALS Baby, Laerdal Medical Corporation, USA). A written evaluation was conducted before and after the intervention. Each pair of residents experienced the two scenarios. Video performance was then assessed and compared. Residents randomly assigned to the hi-fi mannequin rated the experience higher (31+/-3.3 versus 27+/-3.5; P=0.026), and required less redirection from instructors during the megacode (scenario 1: 4.5+/-1.7 versus 15+/-6.9; P=0.015 and scenario 2: 1.8+/-1.3 versus 9.3+/-2.5; P=0.0009) than those who were randomly assigned to the plastic mannequin. Residents randomly assigned to the hi-fi mannequin did not have improved written scores or improved intubation times. The present pilot study demonstrated that a hi-fi mannequin can be used as part of an educational program, such as the NRP. The use of this technology in neonatal resuscitation training is well-received by learners and may provide a more realistic model for training. Further work is required to clarify its role in task performance and team training.