Neonatal Resuscitation Program Research Articles

Rare type of tracheal agenesis: Unexpected presentation and immediate consideration of emergent esophageal intubation in neonatal resuscitation program. Case reports and review of the literature.

Tracheal agenesis, or tracheal atresia, is a rare congenital anomaly. The presence of a tracheoesophageal fistula (TEF) can help with breathing for newborns with tracheal agenesis. In this article, we presented three unique cases and outcomes of neonates with tracheal agenesis along with a review of the literature. This study consisted of a single center case series followed by a review of literature. Case reports were generated using both written and electronic medical records from a single hospital. We summarized three unique cases and outcomes of neonates with tracheal agenesis and performed a review of the literature. We identified three cases of tracheal agenesis presented with severe cyanosis without spontaneous crying upon birth. Experienced pediatricians attempted to intubate the babies but were unsuccessful. Endotracheal tubes were subsequently either accidentally or purposely placed into the esophagus, and oxygen saturation levels improved. This suggested tracheal agenesis with TEF. Two cases underwent surgical intervention after resuscitation with esophageal intubation. Esophageal intubation may be a life-sustaining ventilation support for patients with tracheal agenesis and TEF at initial resuscitation. Clinicians should suspect tracheal agenesis when a newborn presents with severe cyanosis and voiceless crying upon birth, and esophageal intubation should be immediately attempted.

Use of a SimBox, a Video-Augmented, Newborn Resuscitation Simulation for Prehospital Providers to Measure Clinical Performance and Educational Experience.

Few studies have described the current clinical practices, adherence to guidelines, and outcomes of newborn resuscitations attended by emergency medical services (EMS). SimBox, a novel, video-augmented simulation, was used to describe the adherence of prehospital providers to Neonatal Resuscitation Program guidelines, to measure satisfaction with the simulation intervention, and to describe the self-reported improvement in knowledge, skills, and attitudes after the simulation. A prospective observational cohort study of EMS providers was designed and conducted using SimBox, an open-access simulation platform, and facilitated by EMS educators. Clinical performance measures were collected using a five-item checklist. Simulation satisfaction measures were collected through net promoter scores. Learners' demographics, and self-reported knowledge, skills, and attitudes were measured using a retrospective survey of 25 questions. In total, 33 facilitator and 55 learner surveys were collected across Connecticut, Colorado, and Alaska between July 2021 and September 2022. At least one deviation from clinical guidelines occurred in 22/30 (73.3%) of the sessions, with 10/30 (33.3%) teams inappropriately performing chest compressions, 5/31 (16.1%) teams not warming, drying, stimulating, and suctioning the newborn, and 7/31 (22.6%) teams not performing positive pressure ventilation correctly. Lastly, 10/30 (33.3%) teams administered an incorrect dose of dextrose-containing fluids. Very high levels of satisfaction were reported with net promoter scores of 97 and 82 out of 100 for the facilitator and learner surveys, respectively. Finally, all 55/55 (100%) of the learners strongly or somewhat agreed that the simulation improved their knowledge, teamwork, communication, and psychomotor skills. In this cohort of prehospital providers, clinical management decisions during a newborn resuscitation simulation often deviated from the gold-standard, newborn resuscitation guidelines. Free, online, open-access simulation resources like SimBox can be used to identify and measure practice deviations from standardized resuscitation protocols in the prehospital setting.

Opinions and approaches of pediatric surgery specialists and residents about neonatal resuscitation program-nrp: survey study

Aims: The Neonatal Resuscitation Program (NRP) is a course for healthcare professionals who can be called "those who touch the baby at the time of birth". The knowledge and skills obtained through this training program can be used in infant resuscitation at the time of birth and neonatal period resuscitation, which includes the first 30 days of life. It is aimed to evaluate the approaches of pediatric surgeons and research assistants in terms of their opinions and practices regarding NRP, as there are publications in the literature about the NRP experiences of other healthcare professionals. Methods: After receiving the approval of the Ethics Committee,the survey was published as a descriptive and cross-sectional study via the Google Docs system, and the participation of pediatric surgeons and research assistants was requested. Our research was conducted between October 2023 and March 2024 by asking the participants survey form questions via communication tools such as e-mail, telephone, social media, Internet. Data were sent to participants in the form of electronically prepared survey forms via e-mail addresses and social media platforms. It was collected electronically within the date ranges determined for the research. Results: Thirty-seven participants were male, and 40 participants were female. The average age of 77 pediatric surgeons who participated in the survey was determined to be 43.8 years old. Seventeen of the participants are research assistants; 24 of them are specialist physicians; 10 of them are Dr. Lecturers; 12 of them are associate professors; 14 of them were professors. It was determined that 48 of 77 physicians took the NRP course. It has been determined that those who took the NRP course can contribute more to resuscitation practices. Conclusion: It has been stated that pediatric surgeons are familiar with NRP applications and that as clinical experience increases, even among those who have not taken the course, interventions by NRP can be performed. It is seen that pediatric surgeons can effectively participate in NRP courses.

Assessment of pre and post Neonatal Resuscitation program (NRP) training in a neonatal intensive care unit of Pakistan

Assessment of pre and post Neonatal Resuscitation program (NRP) training in a neonatal intensive care unit of Pakistan

The Effects of a Digital Game Simulator versus a Traditional Intervention on Paramedics' Neonatal Resuscitation Performance.

Neonatal resuscitation is a skill set that comprises procedures, assessment, decision-making, communication, and teamwork. It is used in an emergency situation in the delivery room with the aim of supporting newborn infants who are not able to begin breathing on their own. Thus, healthcare providers need to refresh their neonatal resuscitation skills periodically, according to the Neonatal Resuscitation Program, to ensure that they can react quickly and effectively in emergency situations. The RETAIN digital game simulator was designed to enable healthcare providers to practice their neonatal resuscitation skills. To evaluate the effectiveness of this game in a laboratory setting, a randomized control trial sampled 42 paramedics who completed a pre-test, were randomly assigned to watch a traditional lecture video on the neonatal resuscitation procedure or to play a novel digital game simulation on the same topic, and then completed a following test. A two-way mixed ANOVA revealed a statistically significant improvement in paramedics' neonatal resuscitation performance over time, which did not differ between conditions. Thus, digital games can provide an enjoyable alternative to traditional practices in refreshing neonatal resuscitation knowledge.

Development and Effectiveness of a Rapid Cycle Deliberate Practice Neonatal Resuscitation Simulation Program: A Quasi-Experimental Study.

The Rapid Cycle Deliberate Practice (RCDP) simulation during neonatal resuscitation program (NRP) training provides in-event feedback for each simulation step, repeats the simulation from the beginning, and undergoes a continuous improvement process. It also offers after-event debriefing that involves follow-up discussion and reflection after completing simulations. These two methods differ in the timing and frequency of feedback application, and there may be differences in the effectiveness of neonatal resuscitation training. A quasi-experimental simulation study with a pre- and post-test design was used; the experimental group received RCDP simulation NRP training, based on the self-determination theory, while the control group received an after-event debriefing, following the NRP scenario. The experimental group displayed significantly improved clinical decision-making skills compared with the control group. When responding to emergencies involving high-risk newborns, we found that RCDP simulation during NRP training and better preparation for neonatal resuscitation among nursing students improved outcomes for newborns.

Laryngeal mask use during neonatal resuscitation at birth: A United States-based survey of neonatal resuscitation program providers and instructors

AimNeonatal resuscitation guidelines promote the laryngeal mask (LM) interface for positive pressure ventilation (PPV), but little is known about how the LM is used among Neonatal Resuscitation Program (NRP) Providers and Instructors. The study aim was to characterize the training, experience, confidence, and perspectives of NRP Providers and Instructors regarding LM use during neonatal resuscitation at birth. MethodsA voluntary anonymous survey was emailed to all NRP Providers and Instructors. Survey items addressed training, experience, confidence, and barriers for LM use during resuscitation. Associations between respondent characteristics and outcomes of both LM experience and confidence were assessed using logistic regression. ResultsBetween 11/7/22–12/12/22, there were 5,809 survey respondents: 68% were NRP Providers, 55% were nurses, and 87% worked in a hospital setting. Of these, 12% had ever placed a LM during newborn resuscitation, and 25% felt very or completely confident using a LM. In logistic regression, clinical or simulated hands-on training, NRP Instructor role, professional role, and practice setting were all associated with both LM experience and confidence.The three most frequently identified barriers to LM use were insufficient experience (46%), preference for other interfaces (25%), and failure to consider the LM during resuscitation (21%). One-third (33%) reported that LMs are not available where they resuscitate newborns. ConclusionFew NRP providers and instructors use the LM during neonatal resuscitation. Strategies to increase LM use include hands-on clinical training, outreach promoting the advantages of the LM compared to other interfaces, and improving availability of the LM in delivery settings.

Femoral Occlusion during Neonatal Cardiopulmonary Resuscitation Improves Outcomes in an Ovine Model of Perinatal Cardiac Arrest.

The goal of chest compressions during neonatal resuscitation is to increase cerebral and coronary blood flow leading to the return of spontaneous circulation (ROSC). During chest compressions, bilateral femoral occlusion may increase afterload and promote carotid and coronary flow, an effect similar to epinephrine. Our objectives were to determine the impact of bilateral femoral occlusion during chest compressions on the incidence and timing of ROSC and hemodynamics. In this randomized study, 19 term fetal lambs in cardiac arrest were resuscitated based on the Neonatal Resuscitation Program guidelines and randomized into two groups: femoral occlusion or controls. Bilateral femoral arteries were occluded by applying pressure using two fingers during chest compressions. Seventy percent (7/10) of the lambs in the femoral occlusion group achieved ROSC in 5 ± 2 min and three lambs (30%) did not receive epinephrine. ROSC was achieved in 44% (4/9) of the controls in 13 ± 6 min and all lambs received epinephrine. The femoral occlusion group had higher diastolic blood pressures, carotid and coronary blood flow. Femoral occlusion resulted in faster and higher incidence of ROSC, most likely due to attaining increased diastolic pressures, coronary and carotid flow. This is a low-tech intervention that can be easily adapted in resource limited settings, with the potential to improve survival and neurodevelopmental outcomes.

Impact of an Educational Clinical Video Combined with Standard Helping Babies Breathe Training on Acquisition and Retention of Knowledge and Skills among Ethiopian Midwives.

Helping Babies Breathe (HBB) is an evidence-based neonatal resuscitation program designed for implementation in low-resource settings. While HBB reduces rates of early neonatal mortality and stillbirth, maintenance of knowledge and skills remains a challenge. The extent to which the inclusion of educational clinical videos impacts learners' knowledge and skills acquisition, and retention is largely unknown. We conducted a cluster-randomized controlled trial at two public teaching hospitals in Addis Ababa, Ethiopia. We randomized small training group clusters of 84 midwives to standard HBB vs. standard HBB training supplemented with exposure to an educational clinical video on newborn resuscitation. Midwives were followed over a 7-month time period and assessed on their knowledge and skills using standard HBB tools. When comparing the intervention to the control group, there was no difference in outcomes across all assessments, indicating that the addition of the video did not influence skill retention. Pass rates for both the control and intervention group on bag and mask skills remained low at 7 months despite frequent assessments. There is more to learn about the use of educational videos along with low-dose, high-frequency training and how it relates to retention of knowledge and skills in learners.

Immediate Skin to Skin Contact and Zero Separation of Mother Infant Dyads Among Healthy Term Infants Delivered Vaginally: A Quality Improvement Initiative in a Tertiary Care Institute in South India

Background The neonatal resuscitation program (NRP) recommends immediate skin-to-skin contact (SSC) of the neonate with the mother’s abdomen. Early establishment of SSC has increased the duration of breastfeeding and decreased neonatal morbidity significantly. Objective To achieve immediate SSC and zero separation of infant–mother dyads for a minimum of 30 min in vaginally born healthy term babies from 0% to 50% over 3 months by implementing a quality improvement (QI) initiative. Methods A QI initiative was undertaken at the maternity-newborn care unit of a tertiary-care hospital between March 2022 and December 2022. A team including neonatologists, obstetricians, pediatric postgraduates, and nurses (both neonatal and obstetric) in the concerned areas was identified. Using 5-why technique and fishbone analysis, the root cause analysis was done. Two plan-do-study-act (PDSA) cycles were undertaken. First, sensitization of healthcare personnel was done, and a written policy was made. Efforts were made to sustain the QI. Continuous surveillance, internal audits, and regular interprofessional team meetings were carried out. Results Prior to this QI, baseline data showed that no babies received SSC for 30 min. During the first PDSA cycle, 16.6% (4/24) of babies received SSC and zero separation for 30 min. During the II PDSA cycle, among 46 eligible neonates, 50% (23/46) received SSC >30 min. During the sustenance phase, among 262 eligible neonates, 75.2 % (197/262) received >30 min of SSC immediately after delivery. Conclusion Immediate SSC and zero separation for 30 min could be achieved by implementing simple measures through this QI initiative. The major hurdles, including the knowledge gap, fear, and safety of neonates, were tackled through simple strategies like education sessions, ergonomic modification, and sensitization of the healthcare team.

Simulation in a blended learning curriculum for neonatology

Blended learning is a learner-centered educational method that combines online and traditional face-to-face educational strategies. Simulation is a commonly utilized platform for experiential learning and an ideal component of a blended learning curriculum. This section describes blended learning, including its strengths and limitations, educational frameworks, uses within health professions education, best practices, and challenges. Also included is a brief introduction to simulation-based education, along with theoretical and real-world examples of how simulation may be integrated into a blended learning curriculum. Examples of blended learning in Neonatal-Perinatal Medicine, specifically within the Neonatal Resuscitation Program, procedural skills training, and the National Neonatology Curriculum, are reviewed.

Neonatal resuscitation with continuous chest compressions and high frequency percussive ventilation in preterm lambs.

Cerebral oxygen delivery (cDO2) is low during chest compressions (CC). We hypothesized that gas exchange and cDO2 are better with continuous CC with high frequency percussive ventilation (CCC + HFPV) compared to conventional 3:1 compressions-to-ventilation (C:V) resuscitation during neonatal resuscitation in preterm lambs with cardiac arrest induced by umbilical cord compression. Fourteen lambs in cardiac arrest were randomized to 3:1 C:V resuscitation (90CC + 30 breaths/min) per the Neonatal Resuscitation Program guidelines or CCC + HFPV (120CC + HFPV continuously). Intravenous epinephrine was given every 3 min until return of spontaneous circulation (ROSC). There was no difference in the incidence and time to ROSC between both groups. Median (IQR) PaCO2 was significantly lower with CCC + HFPV during CC, at ROSC and 15 min post-ROSC-[104 (99-112), 83 (77-99), and 43 (40-64)], respectively compared to 3:1 C:V-[149 (139-167), 153 (143-168), and 153 (138-178) mmHg. PaO2 and cDO2 were higher with CCC + HFPV during CC and at ROSC. PaO2 was similar 15 min post-ROSC with a lower FiO2 in the CCC + HFPV group 0.4 (0.4-0.5) vs. 1 (0.6-1). In preterm lambs with perinatal cardiac-arrest, continuous chest compressions with HFPV does not improve ROSC but enhances gas exchange and increases cerebral oxygen delivery compared to 3:1 C:V during neonatal resuscitation. Ventilation is the most important intervention in newborn resuscitation. Currently recommended 3:1 compression-to-ventilation ratio is associated with hypercarbia and poor oxygen delivery to the brain. Providing uninterrupted continuous chest compressions during high frequency percussive ventilation is feasible in a lamb model of perinatal cardiac arrest, and demonstrates improved gas exchange and oxygen delivery to the brain. This is the first study in premature lambs evaluating high frequency percussive ventilation with asynchronous chest compressions and lays the groundwork for future clinical studies to optimize gas exchange and hemodynamics during chest compressions in newborns.

A Survey of Academic Neonatologists on Neonatal Electrical Cardioversion and Defibrillation.

This study aimed to assess neonatologists' experience and comfort with neonatal electrical cardioversion or defibrillation (EC-D). Electronic surveys were distributed to academic neonatologists affiliated with 12 Midwest academic hospitals. Neonatologists were asked about their residency training; years since completing residency; current certification/competency training in the Basic Life Support (BLS), Pediatric Advanced Life Support (PALS), Advanced Cardiovascular Life Support (ACLS), and Neonatal Resuscitation Program (NRP); experiences with EC-D; availability of a pediatric cardiologist; and their comfort levels with such procedures. Standard statistical tests evaluated comfort with EC-D. Seventy-two out of 180 neonatologists responded to the survey (response rate = 40%). Of them, 98.6% (71), 54.2% (39), and 37.5% (27) maintained current NRP, BLS, and PALS trainings, respectively. Also, 73.6% (n = 53) reported having performed neonatal EC-D. Of those, 50.9% (n = 27) indicated feeling slightly to very uncomfortable performing EC-D. We report a lack of BLS certification being associated with a lack of comfort (odds ratio [OR]: 0.269, 95% confidence interval [CI]: [0.071, 0.936]), and a positive association between a pediatric cardiologist being present and being uncomfortable (OR: 3.722, 95% CI: [1.069, 14.059]). Those reporting greater volume and more recent experience with EC-D report more comfort. Of neonatologists who performed EC-D, half of them reported being uncomfortable. BLS certification and experience are positively associated with comfort in performing EC-D. Simulations to increase training in EC-D should be offered regularly to academic neonatologists. · Most neonatologists have performed EC-D, but many feel uncomfortable with performing EC-D.. · Many do not maintain current certification in BLS, PALS, or ACLS.. · Simulation training in EC-D will increase comfort with EC-D..

Testing Effect of the National Basic Newborn Resuscitation Educational Program on Midwives’ Knowledge and Skills: Observational Quasiexperimental Study

Background: Basic newborn resuscitation is a vital strategy to reduce the incidence of birth asphyxia and the associated outcomes. These outcomes can be improved if the midwives have the knowledge and skills of basic newborn resuscitation. Purpose: We assessed the midwives' knowledge and their quality of skills regarding BNR, as well as the effectiveness of an educational program in improving midwives' knowledge and skills during the process of BNR. Methods: A pretest-posttest design was conducted. The BNR educational program was adapted from the American Academy of Pediatrics (AAP) Neonatal Resuscitation Program (NRP). It was conducted through three days of workshops, including an overview lecture, interactive video modules, and extensive hands-on teaching of basic resuscitation techniques. Assessments (pre-and post-tests) were performed. Data was analyzed using ttest, one-way ANOVA, relative importance index analysis, and linear regression test. Results:100 midwives attended the workshops. Their mean scores were: knowledge score before the program (M=68.38%, SD= 13.4) and after the program (M=78.72%, SD=10.3), t=6.29, p<0.001. The overall mean prioritization before the program was 2.71(out of 3) and after the program 2.9. The mean quality performance of skills (out of 4 points) before and after the educational program, respectively, were (M=2.2, SD=0.8) and (3.64, SD=0.5). According to multi-variant logistic regression, midwives’ age (years) and weekly to monthly practice of BNR correlated significantly and positively with higher odds of succeeding with a score >= 84% on the knowledge test of post-educational program having been delivered to all the midwives. Conclusion: The study results showed the significant impact of the BNR educational program, followed immediately by the significant improvement in the midwives' knowledge and skills. Implications for Nursing: Midwives and neonatal nurses should be encouraged to upgrade their educational level to ensure their skill retention and expose themselves to BNR. Further, it is essential to understand the factors affecting how midwives and neonatal nurses gain and retain skills using a high-level methodology. Keywords: Basic newborn resuscitation (BNR), Midwives, Knowledge, Skills

Back vs. chest ECG electrode placement in neonatal resuscitation: A pilot randomized controlled trial

BackgroundThe recent Neonatal Resuscitation Program advises the early utilization of an electrocardiogram (ECG) for non-vigorous newborns in the delivery room. However, placing ECG electrodes on the chest may delay obtaining a reliable heart rate (HR) and could interfere with chest compressions. Our previous study showed that preset ECG electrodes, attached to the back of the newborn, are quicker than a pulse oximeter (POX) for detecting HR. AimTo compare time to detect a reliable HR using back-placed ECG electrodes versus standard front placement. MethodsInfants were randomly assigned to back (n = 85) or chest (n = 89) electrode placement. Time measurement began upon placing infants on a Panda warmer ResusView. Failure was defined as no HR detected within 5 minutes. Intention-to-treat analysis compared HR signal acquisition time between groups. ResultsBoth groups showed similar proportions of detectable HR within the first minute. Median (IQR) time to obtain HR was 26 (13,38) seconds for the chest group and 21 (12,54) seconds for the back group (p = 0.91). A large number of vigorous infants were included. In the chest group, these vigorous infants had shorter HR acquisition times than non-vigorous infants (Mean ± SD of 34 ± 48 seconds vs. 50 ± 44 seconds respectively; p = 0.049). Failure rates and time to acquire a HR for infants who were non-vigorous and required advanced resuscitation were similar between the back and chest groups (p = 0.51). ConclusionPreset back ECG electrodes have shown encouraging results in neonates requiring advanced resuscitation. Further studies are needed to enhance guidance during neonatal resuscitation.

Outcomes of neonates born through meconium-stained amniotic fluid pre and post 2015 NRP guideline implementation.

A shift in the Neonatal Resuscitation Program (NRP) guidelines occurred in 2015 from routine intubation and endotracheal suctioning of all meconium-stained non-vigorous infants towards less aggressive interventions based on response to initial resuscitation. This study aims to examine the impact of this change on outcomes of non-vigorous infants born through meconium-stained amniotic fluid at a level III academic NICU encompassing years before and after the change in guideline. This single-center retrospective study compared NICU therapies and clinical outcomes of 117 non-vigorous newborns pre-guideline implementation to 106 non-vigorous newborns post-guideline implementation. Nearly two thirds of infants in the pre-guideline cohort received endotracheal suctioning with recovery of meconium compared to less than a third of infants in the post-guideline cohort (p<0.01). Though a higher proportion of the pre-guideline cohort were admitted to the NICU for respiratory issues compared to the post-guideline cohort, the two groups did not differ significantly with regard to morbidity and therapies. Despite a marked reduction in rates of intubation and endotracheal suctioning, there is no difference in outcomes between pre-guideline implementation vs post-guideline implementation in non-vigorous meconium-stained infants, supporting the recent NRP guideline change and highlighting the benefit of expectant management.

Participation of Trainees, Trainers, and Program Directors of Anesthetists and Anesthesia Technicians in the Neonatal Resuscitation Program in Turkiye

Backgroun/Aims: The Newborn Resuscitation Program aims to ensure that healthcare professionals prevent complications that may occur in the baby, mainly due to asphyxia. Like some other health providers, anesthesia staffs also participate in this program. We aim to determine the rate of participation and contribution of anesthesiologists and anesthesia technicians to programs. We discussed why participation in this program is essential and what results in it will have when evaluated with the after-effects.&#x0D; Method: After the approval of the Gulhane Scientific Research Ethics Committee, the participant records of the courses, which has been organized since 1998, were examined. The records show the number of anesthesia staff according to the total number of people and their distribution by year. We compared total participants to anesthesia staff with the inclusion of trainees, trainers, and course directors in our country. The distribution of these sums and what these numbers might mean were investigated.&#x0D; Results: Only one anesthetist attended the first course as a trainee in 1998. The highest participation as anesthetist and anesthesia technician was in 2010, with 494 participants, 218 and 276, respectively. Since the beginning of the course, 2392 anesthesiologists and 3124 anesthesia technicians out of 75,256 trainees have received training. The average is 3.57 percent. Sixteen out of 47 anesthesiologists and 7 out of 11 anesthesia technicians actively contribute to the programs as trainers. Only five anesthetists and two technicians determined the course directors. All of those directors are active in the program.&#x0D; Conclusion: The number of trainers and course directors is relatively low compared to the total number of people working in the anesthesia branch nationwide. As anesthesia staff is critical for neonatal resuscitations, increasing anesthesia staff participation can significantly reduce neonatal mortality and morbidity.

Laryngeal Mask Airway Clinical Use and Training: A Survey of North American Neonatal Health Care Professionals.

The aim of this study was to explore North American neonatal health care professionals' (HCPs) experience, confidence, skill, and training with the laryngeal mask airway (LMA). This was a cross-sectional survey. The survey was completed by 2,159 HCPs from Canada and the United States. Seventy nine percent had no clinical experience with the LMA, and less than 20% considered the LMA an alternative to endotracheal intubation (EI). The majority had received LMA training; however, 28% of registered nurses, 18% of respiratory therapists, 17% of physicians, and 12% of midwives had never inserted an LMA in a mannequin. Less than a quarter of respondents agreed that the current biennial Neonatal Resuscitation Program instruction paradigm is sufficient for LMA training. All groups reported low confidence and skill with LMA insertion, and compared with all other groups, the respiratory therapists had the highest reported confidence and skill. This survey study, which is the first of its kind to include midwives, demonstrates that neonatal HCPs lack experience, confidence, skill, and training with the LMA, rarely use the device, and in general, do not consider the LMA as an alternative to EI. These findings contribute to, and support the findings of previous smaller studies, and in conjunction with the diminishing opportunities for EI, highlight the need for programs to emphasize the importance of the LMA for neonatal airway management and prioritize regular LMA training, with focus that parallels the importance placed on the skills of EI and mask ventilation. · Lack of training for laryngeal mask airway use in neonatal resuscitation.. · Neonatal health care professionals rarely use the laryngeal mask airway as an alternate airway device.. · Neonatal health care professionals lack confidence and skill with the laryngeal mask airway..

A recorder/time coach decreases time errors during neonatal resuscitation: A randomized, simulation-based clinical trial

AimTo evaluate the effects of a hands-off recorder/time coach versus an additional hands-on healthcare provider on Neonatal Resuscitation Program (NRP) algorithm compliance and team member workload in neonatal resuscitations. MethodsTwo interventions were studied using a 2 × 2 factorial design: an additional hands-on team member and the presence of a designated, hands-off recorder/time coach. The recorder/time coach documented interventions and delivered pre-specified prompts at defined points during the resuscitation. The primary outcome was cumulative time error. Secondary outcomes were time to first dose of IV epinephrine, overall team performance as assessed by the Neonatal Resuscitation Performance Evaluation (NRPE) score, and workload assessed by the NASA Task Load Index (NASA TLX). Results64 teams were studied. Teams with a recorder had a significantly lower cumulative time error compared to teams without a recorder (p < 0.001). An additional hands-on team member did not change cumulative time error. There was no difference in time to first dose of IV epinephrine or NRPE score in these comparisons. Ad-hoc analysis did reveal a significant increase in time to IV epinephrine in teams with the minimum of four total members (p = 0.025). A recorder/time coach increased team leader NASA TLX overall workload score (p = 0.047), but an additional hands-on team member did not. ConclusionA designated, hands-off recorder/time coach improved compliance by decreasing cumulative time error in teams performing complex simulated neonatal resuscitations.

Improving Delivery of Positive Pressure Ventilation During Neonatal Resuscitation: A Quality Improvement Study

Background Positive pressure ventilation (PPV) is one of the most crucial steps of the Neonatal Resuscitation Program (NRP) algorithm. We observed multiple deviations from NRP algorithm during PPV delivery in our unit for which we planned a quality improvement (QI) initiative. The aim of this study was to improve PPV score (total score 14) from existing 20% (~3) to at least 60% (~8) during neonatal resuscitation in delivery room and maternity OT over a period of 48 weeks. Methods The study was conducted in 3 phases over a period of 48 weeks. The baseline and the sustenance phase were of 12 weeks and the intervention phase consisting of 4 PDSA cycles was of 24 weeks duration. Several change ideas were tested and implemented during these PDSA cycles including training sessions for effective PPV delivery, ensuring adequate number of personnel attending delivery and equipment check, specification of delivery team at the start of a shift, and involvement of obstetrics colleagues for better communication. The objective scoring of PPV (a total composite score of 14 over 7 domains) was taken as the process measure, while the proportion of deliveries with PPV score &gt;60% (~8) and need for alternate airway were the outcome measures. We used statistical process control (SPC) Xbar mean chart and P charts for analyzing the data. Results The median score during the baseline phase was 20% (3/14) which improved to 71% (10/14) during the sustenance phase. The percentage of deliveries having a score of at least 60% (8/14) also improved significantly from the baseline to the sustenance phase; there was, however, no change in the need for alternate airway. Conclusion This QI study successfully improved the PPV delivery practices. Similar studies involving multiple centers and including other steps of NRP algorithm should be undertaken for the overall betterment of neonatal care and outcomes. What Is Known NRP is an evidence-based approach for neonatal resuscitation; however, evidence suggests that the quality and sequence of events during neonatal resuscitation significantly deviate from the standard guidelines. What This Study Adds QI is an excellent tool to improve the adherence to PPV delivery during newborn resuscitation. Along with training and teaching of the care giving staff, the study identified important gaps in PPV delivery which were solved using simple and comprehensive measures.