Neonatal Resuscitation Course Research Articles

Knowledge of General Practitioner Doctors and Midwives Who Has and Has Not Attended Neonatal Resuscitation Course Has No Significant Difference

Introduction: Infant death is most prominent in the neonatal period. The success of neonatal resuscitation practice has many contributing factors. One of which is the health workers’ knowledge of the Neonatal Resuscitation Program (NRP) algorithm. Therefore, it is necessary to conduct studies to evaluate the health workers’ knowledge of the Neonatal Resuscitation Program who are educated in neonatal resuscitation course and has taken part in Neonatal Life Support practice in primary health care (PHC) Objective: This study aims to analyze the knowledge of general practitioners and midwives who has or has not attended in neonatal resuscitation course in Surabaya PHC Methods and Materials: this research is descriptive, cross-sectional research. All Basic Emergency Obstetric and Newborn Care (BEmONC) PHC in Surabaya which are Jagir PHC, Banyu Urip PHC, Medokan Ayu PHC, Tanah kali Kedinding PHC, Tanjungsari PHC, Balongsari PHC, Sememi PHC, Simomulyo PHC is included in this research from 2018 to 2019. A nine-item questionnaire referenced from The Textbook of Neonatal Resuscitation 7th Edition is given to ten respondents in each BEmONC PHC. Results and Discussion: from the total sample of 78 respondents, 32 (41,0%) receive a high score, 20 (25,7%) receive a middle score, and 26 (33,3%) receive a low score. The data shows that there is no significant score difference between respondents who has or has not participate in the NRP course (p=0,419). Conclusion: There is no correlation between difference knowledge midwives and general practitioners who had and had not attended neonatal resuscitation training at basic emergency obstetric and newborn care in public health center Surabaya.

Problems and thoughts in the application of neonatal resuscitation technology in rural primary hospitals

Neonatal resuscitation project to rural grass-roots development is different from urban promotion and application, need to adjust appropriate strategies and measures. Correct understanding of the effectiveness of resuscitation technology can improve the compliance of rural grass-roots promotion and application. According to Renewal of International Neonatal Resuscitation Course and China′s Implementation Opinions, we should make the training of recovery teams as an important goal of long-term management, And adhere to case one preparation, one monitoring, one week one review. Rural grass-roots units should innovate and popularize application methods according to local conditions. It is suggested that the training system for neonatal resuscitation and post-resuscitation treatment should be gradually established in county (city) areas. Key words: Neonatal resuscitation; Asphyxia; Rural areas; Basic level; Training

Prematurity: A Major Cause of Early Neonatal Mortality in Ad-din Medical College Hospital

Objective: Early neonatal mortality within the fi rst 24 hours contributes substantially to overall neonatal mortality rates. Reliable cause- specific mortality data are limited; thus the estimated proportion of prematurity-related deaths nationally remains questionable. The objective was to determine the presumed causes of neonatal death within the fi rst 24 hours in Ad-din Medical College Hospital.
 Methods: This is a retrospective study initiated in January of 2016 to December 2016, conducted in the delivery room and adjacent neonatal area at Ad-din Medical College Hospital. Research assistants were trained to observe and record events related to labor, neonatal resuscitation, and 24-hour postnatal course. Perinatal asphyxia (PNA) was defined as failure to initiate spontaneous respirations and/or 5-minute Apgar score <7, prematurity as gestational age <37 weeks, and low birth weight (LBW) as birth weight (BW) < 2500gm. Data were analyzed with using the SPSS version (Chi-Square test).
 Results: Over 1 year, 14316 neonates were born and evaluated. Of these, 1867 were admitted to the neonatal area. Twenty seven neonates died secondary to Prematurity (55.56%), PNA (37.03%) and Meconium aspiration syndrome (7.41%).
 Conclusions: Most cases of early neonatal mortality were related to Prematurity and its related complications and Perinatal asphyxia are additional important considerations. Reducing Perinatal mortality requires a multifaceted approach with attention to issues related to potential complications of Prematurity and its related complications and PNA.
 Bangladesh Journal of Medical Science Vol.18(3) 2019 p.593-597

GROWTH MINDSET MODERATES THE IMPACT OF NEONATAL RESUSCITATION SKILL MAINTENANCE ON PERFORMANCE IN A SIMULATION TRAINING VIDEO GAME

Abstract BACKGROUND The Joint Commission on Accreditation of Healthcare Organizations (2004) reporting on preventing infant death and injury during delivery identified human errors during neonatal resuscitation as responsible for more than two thirds of perinatal mortality and morbidity. One of the main causes of human error in neonatal resuscitation stems from a lack of practical learning experiences highlighted by the neonatal training paradox of high-acuity, low-occurrence (HALO) situations that arise infrequently. simulation-based medical education (SBME) is resource and cost intensive, and not offered frequently enough for development of competency and for supporting knowledge retention. Therefore, other methods of training to improve knowledge retention and decision-making are needed. We therefore developed a complementary tool to the physical SBME to improve knowledge retention during neonatal resuscitation in the delivery room. Specifically, we developed a game-based neonatal resuscitation training simulator called RETAIN. OBJECTIVES We hypothesized that HCP playing the video game will have an improved mindset and therefore an improved neonatal resuscitation performance. DESIGN/METHODS HCPs trained in NRP, including registered nurses, respiratory therapists, neonatal nurse practitioners, neonatal consultants, and neonatal fellows were recruited from the Royal Alexandra Hospital, a tertiary NICU. Each participant was asked to complete a pre-game questionnaire to obtain demographics (e.g. last Neonatal Resuscitation Course (NRP)-course, years of experience) and assess their neonatal resuscitation knowledge by completing a Resuscitation scenario. Afterwards each participant played the RETAIN simulator, which started with a tutorial before the actual three rounds and there was a countdown for each of the rounds to simulate the stress of a real-world scenario. After completion of the game each participant also completed a Post-game questionnaire to assess the player’s mindset (e.g. How much do you agree with the following statements? You can always change how good you are at your job or You can get better at your job with practice) using a Likert scale (1=Strongly Disagree to 5=Strongly agree). RESULTS We recruited 50 (45 females, 4 males, and 1 not reported) HCP who were all NRP-trained and had completed a NRP refresher course within the last 24 months. Participants needed a mean (SD) 8.47 (8.66) minutes to complete the game. On average, participants reported high levels of growth mindset (with scores ranging from seven to ten), took their latest NRP course more than eight months prior to the current study, and scored 93% in the game (32 was a perfect score). Interestingly, participants who took the NRP course more recently made more mistakes in the simulation game. There was a significant interaction of Last NRP Course and Growth Mindset in predicting Number of Tries (b =.09, S.E.=.04, beta=.32, t=2.25, p=.03), as well as a main effect for Last NRP Course (b= -.08, S.E.=.04, beta=-.30, t=-2.04, p<.05). Thus, participants who took an NRP course recently (i.e., within eight months), before the current study, completed the game in significantly fewer tries when they endorsed more rather than less of a growth mindset. However, participants who endorsed more of a growth mindset performed similarly on the game regardless of when they took the NRP course. CONCLUSION The study examined the relation between HCP task performance and time elapsed since their latest NRP course and found that growth mindset moderates this relation. Specifically, HCP who took the NRP course within the past eight months, those who endorsed a higher growth mindset made fewer mistakes in a simulation game. Some implications include growth mindset interventions and increased opportunities to practice skills in simulation sessions to help HCP achieve better performance after taking a refresher NRP course.

Opinions regarding neonatal resuscitation training for the obstetric physician: a survey of neonatal and obstetric training program directors

Purpose: Our goal was to garner opinions regarding neonatal resuscitation training for obstetric physicians. We sought to evaluate obstacles to neonatal resuscitation training for obstetric physicians and possible solutions for implementation challenges. Materials and methods: We distributed a national survey via email to all neonatal-perinatal medicine fellowship directors and obstetrics & gynecology residency program directors in the United States. This survey was designed by a consensus method. Results: Ninety-eight (53%) obstetric and fifty-seven (51%) neonatal program directors responded to our surveys. Eighty-eight percent of neonatologists surveyed believe that obstetricians should be neonatal resuscitation program (NRP) certified. The majority of surveyed obstetricians (>89%) believe that obstetricians should have some neonatal resuscitation training. Eighty-six percent of obstetric residents have completed training in NRP, but only 19% of obstetric attendings are NRP certified. Major barriers to NRP training that were identified include time, lack of national requirement, lack of belief it is helpful, and cost. Conclusions: Most obstetric attendings are not NRP certified, but the majority of respondents believe that obstetric providers should have some neonatal resuscitation training. Our study demonstrates that most respondents support a modified neonatal resuscitation course for obstetric physicians.

Survey of neonatal resuscitation practices showed post-training improvements but need to reinforce preterm management, monitoring and adrenaline use.

Neonatal resuscitation surveys have showed practice variations between countries, centres and levels of care. We evaluated delivery room practices after a nationwide neonatal resuscitation training programme focused on nontertiary centres. A 2012 survey sent to all Spanish hospitals handling deliveries covered staff availability and training, equipment and practices in the delivery room and during transfers to neonatal intensive care units. The results from 98 centres that had completed a previous survey in 2007 were analysed by levels of care. Pearson's chi-square test was used to compare the proportions. The following had significantly improved in 2012 compared to 2007: the availability of T-piece resuscitators (71.4% vs. 41.8%), plastic wraps (69.4% vs. 31.6%), gas blenders (79.6% vs. 40.8%), pulse oximetry (92.9% vs. 61.2%), use of continuous positive airway pressure (82.7% vs. 43.9%) (all p < 0.01), the availability of instructors (55.6% vs. 83.3%, p < 0.05) and neonatal resuscitation courses (40.8% vs. 79.6%, p < 0.05) in nontertiary centres. In 2012, the use of exhaled carbon dioxide detectors was <7% and endotracheal administration of adrenaline was >90%. Neonatal resuscitation equipment and practices improved over time, but several aspects needed to be reinforced in training programmes, namely preterm infants' management, monitoring and adrenaline administration.

Participants' opinions of the limited impact of an adapted neonatal resuscitation course in a low-resource setting.

Participants' opinions of the limited impact of an adapted neonatal resuscitation course in a low-resource setting.

Performances of low level hospital health caregivers after a neonatal resuscitation course.

BackgroundHigh fidelity simulation has been executed to allow the evaluation of technical and non-technical skills of health caregivers. Our objective was to assess technical and non-technical performances of low level hospitals health caregivers who attended a Neonatal Resuscitation course using high fidelity simulation in a standard-setting scenario.MethodsTwenty-three volunteers were asked to manage a simple scenario (infant with secondary apnea) after the course. Technical and non-technical skills were assessed by using previously published scores. Performances were assessed during the scenario and after 2 months by filmed video recordings.ResultsSixteen (69.5%) participants failed to pass the minimum required technical score. Staff experience and participation in previous courses were associated to higher score in technical and non-technical skills, while working in level I or II hospitals did not affect the scores. Previous experience in neonatal resuscitation requiring positive pressure ventilation was associated to better non-technical performance. Technical and non-technical scores were significantly correlated (r = 0.67, p = 0.0005). Delayed and direct evaluation of technical skills provided the same scores.ConclusionsA neonatal resuscitation course, performed by using a high fidelity simulation manikin, had a limited impact on technical and non-technical skills of participants working in low level hospitals. Training programs should be tailored to the participants’ professional background and to the more relevant sessions.

Five years after the Spanish neonatal resuscitation survey. Are we improving?

Introduction An analysis is presented of delivery room (DR) neonatal resuscitation practices in Spanish hospitals. Methods A questionnaire was sent by e-mail to all hospitals attending deliveries in Spain. Results A total of 180 questionnaires were sent, of which 155 were fully completed (86%). Less than half (71, 46%) were level I or II hospitals, while 84 were level III hospital (54%). In almost three-quarters (74.2%) of the centres, parents and medical staff were involved in the decision on whether to start resuscitation or withdraw it. A qualified resuscitation team (at least two members) was available in 80% of the participant centres (63.9% level I–II, and 94.0% level III, P < .001). Neonatal resuscitation courses were held in 90.3% of the centres. The availability of gas blenders, pulse oximeters, manual ventilators, and plastic wraps was higher in level III hospitals. Plastic wraps for pre-term hypothermia prevention were used in 63.9% of the centres (40.8% level I–II and 83.3% level III, P < .001). Term newborn resuscitation was started on room air in 89.7% of the centres. A manual ventilator (T-piece) was the device used in most cases when ventilation was required (42.3% level I–II and 78.6% level III, P < .001). Early CPAP in preterm infants was applied in 91.7% of the tertiary hospitals. In the last 5 years some practices have improved, such as neonatal resuscitation training, pulse oximeter use, or early CPAP support. Conclusions There is an improvement in some practices of neonatal resuscitation. Significant differences have been found regarding the equipment or practices in the DR, when comparing hospitals of different levels of care.

Effect of a Neonatal Resuscitation Course on Healthcare Providers' Performances Assessed by Video Recording in a Low-Resource Setting.

BackgroundWe assessed the effect of an adapted neonatal resuscitation program (NRP) course on healthcare providers’ performances in a low-resource setting through the use of video recording.MethodsA video recorder, mounted to the radiant warmers in the delivery rooms at Beira Central Hospital, Mozambique, was used to record all resuscitations. One-hundred resuscitations (50 before and 50 after participation in an adapted NRP course) were collected and assessed based on a previously published score.ResultsAll 100 neonates received initial steps; from these, 77 and 32 needed bag-mask ventilation (BMV) and chest compressions (CC), respectively. There was a significant improvement in resuscitation scores in all levels of resuscitation from before to after the course: for “initial steps”, the score increased from 33% (IQR 28–39) to 44% (IQR 39–56), p<0.0001; for BMV, from 20% (20–40) to 40% (40–60), p = 0.001; and for CC, from 0% (0–10) to 20% (0–50), p = 0.01. Times of resuscitative interventions after the course were improved in comparison to those obtained before the course, but remained non-compliant with the recommended algorithm.ConclusionsAlthough resuscitations remained below the recommended standards in terms of quality and time of execution, clinical practice of healthcare providers improved after participation in an adapted NRP course. Video recording was well-accepted by the staff, useful for objective assessment of performance during resuscitation, and can be used as an educational tool in a low-resource setting.

Encuesta española de reanimación neonatal 5 años después. ¿Vamos mejorando?

IntroductionAn analysis is presented of delivery room (DR) neonatal resuscitation practices in Spanish hospitals. MethodsA questionnaire was sent by e-mail to all hospitals attending deliveries in Spain. ResultsA total of 180 questionnaires were sent, of which 155 were fully completed (86%). Less than half (71, 46%) were level i or ii hospitals, while 84 were level iii hospital (54%). In almost three-quarters (74.2%) of the centres, parents and medical staff were involved in the decision on whether to start resuscitation or withdraw it. A qualified resuscitation team (at least two members) was available in 80% of the participant centres (63.9% level i-ii, and 94.0% level iii, P<.001). Neonatal resuscitation courses were held in 90.3% of the centres. The availability of gas blenders, pulse oximeters, manual ventilators, and plastic wraps was higher in level iii hospitals. Plastic wraps for pre-term hypothermia prevention were used in 63.9% of the centres (40.8% level i-iiand 83.3% level iii, P<.001). Term newborn resuscitation was started on room air in 89.7% of the centres. A manual ventilator (T-piece) was the device used in most cases when ventilation was required (42.3% level i-iiand 78.6% level iii, P<.001). Early CPAP in preterm infants was applied in 91.7% of the tertiary hospitals. In last 5 years some practices have improved, such neonatal resuscitation training, pulse oximeter use, or early CPAP support. ConclusionsThere is an improvement in some practices of neonatal resuscitation. Significant differences have been found as regards the equipment or practices in the DR, when comparing hospitals of different levels of care.

Training of neonatal cardiopulmonary resuscitation instructors.

The Consensus on Science and Treatment Recommendations 2010 supported simulation-based training for education in resuscitation. This approach has been introduced into neonatal cardiopulmonary resuscitation (NCPR) courses in Japan, but no method for teaching instructors has been established. We developed a course for training instructors of NCPR, with inclusion of an instruction practice program. The goal of the study was to evaluate the performance of instructors who completed the course. Based on problems in the conventional instructor training course (old course 1), we developed and implemented a new course. Persons who had completed an NCPR course took the new course after developing two resuscitation scenarios. The new course included lectures and instruction practice, in which participants provided instruction using these scenarios. Instruction by participants was evaluated, and knowledge, opinions and satisfaction were examined by questionnaire after the course. Activity of the participants as instructors for 6 months after certification was also evaluated. The performance of trained instructors was compared between the old and new courses. Of 143 participants in the new course, > 90% had confidence to teach NCPR, while only 50-60% of the 89 participants in the old course indicated that they could instruct on resuscitation procedures and practice (P < 0.001). All participants in the new course recognized the value of scenario practice and all were glad they had taken the course. For 6 months after certification, significantly more participants who had done the new course worked as instructors compared with those who had done the old course (60% vs 34%, P < 0.001). This is the first trial of a resuscitation training course using scenarios that participants developed themselves. A new course including instruction practice for training NCPR instructors was effective for improving instructor performance.

Neonatal Resuscitation at a privately owned tertiary hospital in Nigeria: Knowledge gap among Health workers and need for sustenance

Objective: Neonatal resuscitation has evolved over the last three decades from word of mouth teachings to organised methods. Resuscitation efforts are geared towards mitigating the adverse sequalae of perinatal asphyxia. To evaluate the cognitive knowledge of health workers primarily involved in care of newborn on neonatal resuscitation and document the effects neonatal resuscitation training course have on improving the knowledge of health workers.&#x0D; Method: Standardized pre-test and post-test as used by American Academy of Pediatrics and American Heart Association (AAP/AHA) were administered to the health workers who participated in the neonatal resuscitation training course. Nurses and doctors were from three key departments- Paediatrics, Anaesthesia and, Obstetrics and Gynaecology. The pass mark was set at a cut-off score of ≥ 70%. &#x0D; Results: Thirty health workers participated in the neonatal resuscitation course. 70% of them were nurses while 30% were doctors. 70% of the participants were from the department of paediatrics while participants from Anaesthesia and Obstetrics and Gynaecology accounted for 16.7% and 13.3% respectively. The mean pre-test and post-test scores among all participants were 40.65±18.05 and 68.00±16.36 respectively (p&lt; 0.001). Participants from paediatrics performed better than other specialties (p &lt;0.001).&#x0D; Conclusion: There is an obvious knowledge gap among health workers directly involved in the care of the new born. Neonatal resuscitation training coursesand regular retraining can bridge this gap in knowledge.

PC.75 An iPad application to revise and self assess the resuscitation Council (UK) Newborn Life Support (NLS) algorithm

IntroductionDegradation in resuscitation skills is well documented and regular updates are helpful.1 We have published high neonatal resuscitation assessment failure rates in trainees certified as NLS providers.2 Our objectives were...

Interprofessional Teamwork Training in Neonatal Resuscitation Using TeamSTEPPS and Event-Based Approach Simulation

Abstract Introduction The Interprofessional Teamwork Training in Neonatal Resuscitation course includes a mix of didactic and simulation-based learning activities. The didactic teamwork and communi...

Improving Assessment During Noninvasive Ventilation in the Delivery Room

The efficacy of mask ventilation has traditionally been judged by evaluating clinical signs alone (eg, assessment of heart rate, chest movements, skin color), which can be misleading. Despite the recent introduction of extended noninvasive monitoring, neonatal resuscitation remains challenging. This article discusses the current evidence on clinical assessment and monitoring during noninvasive mask ventilation in the delivery room. Potential pitfalls during mask ventilation are discussed, which may be identified with structured neonatal resuscitation courses, video recording, or extended physiological monitoring. Successful placement of a correctly positioned endotracheal tube by junior medical staff is &amp;lt;50%, and accidental esophageal intubation is common. Clinical signs are subjective and can be misleading, and recognition of esophageal placement of the endotracheal tube, by using clinical assessment alone, can take up to several minutes. Because carbon dioxide is exhaled at much higher concentrations than inhaled, it can be detected with semiquantitative colorimetric devices, or devices that display numeric or graphic values. In the section on carbon dioxide detectors, the current evidence (along with limitations) concerning these devices is discussed.

Birth Asphyxia: A Major Cause of Early Neonatal Mortality in a Tanzanian Rural Hospital

Early neonatal mortality within the first 24 hours contributes substantially to overall neonatal mortality rates. The definition of birth asphyxia (BA) is imprecise, and reliable cause-specific mortality data are limited; thus the estimated proportion of BA-related deaths globally remains questionable. The objective was to determine the presumed causes of neonatal death within the first 24 hours in a rural hospital in Northern Tanzania. This is a prospective descriptive observational study conducted in the delivery room and adjacent neonatal area. Research assistants were trained to observe and record events related to labor, neonatal resuscitation, and 24-hour postnatal course. BA was defined as failure to initiate spontaneous respirations and/or 5-minute Apgar score <7, prematurity as gestational age <36 weeks, and low birth weight (LBW) as birth weight <3rd centile for gestational age. Data were analyzed with χ(2) and Student's t tests. Over 1 year, 4720 infants were born and evaluated. Of these, 256 were admitted to the neonatal area. Forty-nine infants died secondary to BA (61%), prematurity (18%), LBW (8%), infection (2%), congenital abnormalities (8%), and unclear reason (2%). The 5-minute Apgar score was ≥7 in 50% of the infants who died secondary to BA. Most cases of early neonatal mortality were related to BA, and prematurity and LBW are additional important considerations. Reducing perinatal mortality requires a multifaceted approach with attention to issues related to BA, potential complications of prematurity, and LBW. The 5-minute Apgar score is a poor surrogate of BA.

Effect of neonatal resuscitation courses on long‐term neurodevelopmental outcomes of newborn infants with perinatal asphyxia

In previous studies, it has been demonstrated that Neonatal Resuscitation Program (NRP) courses improve the early outcomes of infants with perinatal asphyxia, but there has been no evidence to demonstrate the effect of NRP on long-term outcomes of perinatal asphyxia. The goal of the present study was to determine the effect of NRP courses on the long-term neurodevelopmental outcome of perinatal asphyxia. This prospective study included infants referred to the Neonatal Unit during the years 2003-2005. Those patients who were referred before NRP courses (pretraining period) were designated as group 1, those who were referred after the first NRP course (transition period) as group 2, and those who were referred after the second NRP course (post-training period) as group 3. Neurodevelopmental outcomes were assessed and compared at 4-6 years of age. The study involved 40 patients: 23 in group 1, nine in group 2 and eight in group 3. The number of patients who had been diagnosed with cerebral palsy was 13 in group 1, two in group 2, and one in group 3, which was a significant decrease. The number of patients with seizures and electroencephalography abnormality was 12 and 14 in group 1, three and two in group 2, and one and one in group 3, respectively, which was also a significant decrease. NRP courses have positive effects on short-term as well as long-term neurodevelopmental outcomes of infants with perinatal asphyxia. Further studies are required to determine the effects of NRP courses on minor deficits, such as cognitive and behavioral disturbances.

Self-directed Versus Traditional Classroom Training for Neonatal Resuscitation

Neonatal Resuscitation Program instructors spend most of their classroom time giving lectures and demonstrating basic skills. We hypothesized that a self-directed education program could shift acquisition of these skills outside the classroom, shorten the duration of the class, and allow instructors to use their time to facilitate low-fidelity simulation and debriefing. Novice providers were randomly allocated to self-directed education or a traditional class. Self-directed participants received a textbook, instructional video, and portable equipment kit and attended a 90-minute simulation session with an instructor. The traditional class included 6 hours of lectures and instructor-directed skill stations. Outcome measures included resuscitation skill (megacode assessment score), content knowledge, participant satisfaction, and self-confidence. Forty-six subjects completed the study. There was no significant difference between the study groups in either the megacode assessment score (23.8 [traditional] vs 24.5 [self-directed]; P = .46) or fraction that passed the "megacode" (final skills assessment) (56% [traditional] vs 65% [self-directed]; P = .76). There were no significant differences in content knowledge, course satisfaction, or postcourse self-confidence. Content knowledge, years of experience, and self-confidence did not predict resuscitation skill. Self-directed education improves the educational efficiency of the neonatal resuscitation course by shifting the acquisition of cognitive and basic procedural skills outside of the classroom, which allows the instructor to add low-fidelity simulation and debriefing while significantly decreasing the duration of the course.

Laryngeal Mask Airway for neonatal resuscitation in a developing country: evaluation of an educational intervention. Neonatal LMA: an educational intervention in DRC

BackgroundStudies carried out in developing countries have indicated that training courses in newborn resuscitation are efficacious in teaching local birth attendants how to properly utilize simple resuscitation devices. The aim of this study was to assess the knowledge and expertise gained by physicians and midwifes who participated in a Neonatal Resuscitation Course and workshop organized in a Third World Country on the use of Laryngeal Mask Airway (LMA).MethodsA 28-item questionnaire, derived from the standard test contained in the American Heart Association and the American Academy of Pediatrics Neonatal Resuscitation Manual, was administered to 21 physicians and 7 midwifes before and after a course, which included a practical, hands-on workshop focusing on LMA positioning and bag-ventilation in a neonatal manikin.ResultsThe knowledge gained by the physicians was superior to that demonstrated by the midwifes. The physicians, in fact, demonstrated a significant improvement with respect to their pre-course knowledge. Both the physicians and the midwives showed a good level of expertise in manipulating the manipulating the manikin during the practical trial session. The midwifes and physicians almost unanimously manifested a high degree of approval of neonatal resuscitation by LMA, as they defined it a sustainable and cost-effective method requiring minimal expertise.ConclusionsFurther studies are warranted to test the advantages and limits of the neonatal LMA training courses in developing countries.