Neonatal Resuscitation Training Research Articles

Neonatal Respiratory Care

Acute respiratory failure caused by different origins continues to be the major etiology of morbidity and mortality in critical neonates. There has been much advancement in neonatal respiratory care, but a few neonates with severe respiratory failure continue to be candidates for extracorporeal membrane oxygenation or survive with chronic lung diseases (CLD). Therefore, searching for ideal respiratory care strategies to reduce the morbidity and mortality rates is crucial for caring critical neonates. The main aim of this special issue was focused on the existing and potential strategies or techniques in neonatal respiratory care. In this special issue, we have invited a few papers that address such issues. Meconium aspiration syndrome (MAS) is a common cause of severe respiratory failure in term infants. The associations of persistent pulmonary hypertension of newborn (PPHN), pulmonary air leaks, and other morbidities sometimes make the respiratory care a difficult challenge to neonatologists. Three papers address current respiratory care in MAS. In a paper by K. Swarnam et al. they have a detail review on the epidemiology, pathophysiology, and managements in many different views of MAS. In another paper, P. Dargaville focuses on the application of mechanical respiratory supports in MAS, as well as the role of adjunctive respiratory therapies. In a paper, by C. Fischer et al., they demonstrate the epidemiology of MAS in term neonates using a population-based retrospective study for all births from 2000 to 2007 in a French region (Burgundy). In addition, bronchopulmonary dysplasia (BPD)/chronic lung disease (CLD) continues to be a major cause of neonatal morbidity in spite of significant progress in the treatment of preterm neonates. We have two articles discussing the pharmacologic approaches for prevention and treatment of BPD/CLD. S. Gupta et al. focus on the use of corticosteroids in one paper, and K. Tropea reviews all possible medications and the future potential stem cell therapy in another one. Furthermore, research papers discussing other important clinical issues in neonatal respiratory care are included. In a paper by S. Rastogi et al., they report their analysis on the factors associated with the successful weaning from nasal continuous positive airway pressure (NCPAP). In a paper by A. Gentili et al., they report their analysis on the duration of preoperative stabilization in predicting outcome of congenital diaphragmatic hernia. In a paper by K. Hole et al., they report the impact of neonatal resuscitation training in neonatal mortality rates in Malawi, Africa. Mei-Jy Jeng Tsu F. Yeh Peter A. Dargaville Thomas H. Shaffer Jen-Tien Wung

Teaching Medical Students Neonatal Resuscitation: Knowledge Gained and Retained from a Brief Simulation-based Training Workshop

Despite being an essential clinical skill, many junior doctors feel unprepared to perform neonatal resuscitation. We introduced a neonatal resuscitation training workshop in 2009 for our final-year medical students. We assessed the effectiveness of our workshop in improving knowledge immediately post-training and at the end of the year. We retrospectively analysed the data of our students who attended the workshops during their Paediatric posting in small groups. The workshop was adapted from the American Academy of Paediatrics (AAP) Neonatal Resuscitation Provider (NRP) programme, and included overview lectures, practical simulation, interactive video scenarios and assessments (pre- and post-tests), which comprised 21 multiple-choice questions covering evaluation, practical actions and theory. We repeated the assessment in the final week of the students' medical training ("final test"). We analysed the data using paired t-test, analysis of variance (ANOVA), linear regression and Friedman's test. All 56 students attended the workshops. Their mean scores (out of 21) were 11.7 (SD 2.5) (pre-test), 16.2 (SD 1.9) (post-test) and 13.6 (SD 2.3) (final test) (P ≤ 0.001 for all pair-wise comparisons). The workshop's timing (earlier or later in the year) had no relationship with the students' final test scores (P = 0.96). In the final test, 68.5%, 67.4% and 60.6% on average answered correctly questions on practical action, theory and evaluation, respectively (P = 0.03). Our workshop produced a modest gain in student knowledge on neonatal resuscitation at the end of their medical course. The students' overall gain in knowledge was below our expectation, and evaluation appeared to be their weakest domain. Further research should evaluate strategies to enhance longer-term knowledge retention with practical performance.

Neonatal Resuscitation Skills Among Pediatricians and Family Physicians: Is Residency Training Preparing for Postresidency Practice?

Pediatricians and family physicians are responsible for providing newborn resuscitation, yet Accreditation Council for Graduate Medical Education requirements for training in this area during residency differ markedly for the two specialties. Our objectives were to determine (1) the extent to which neonatal resuscitation training differs for pediatric and family medicine residents; (2) the extent to which general pediatricians and family physicians engage in newborn resuscitation in their practice; and (3) whether use of resuscitation skills differs between urban/suburban and rural providers. We surveyed a national cohort of pediatricians and family physicians who obtained board certification between 2001 and 2005. Data were analyzed based on type of physician and setting of current practice. Survey response rate was 22% (382 of 1736). Compared with family medicine physicians, pediatricians received more neonatal resuscitation training during residency. Most members of both groups had attended no deliveries in the year prior to the survey (75% [111 of 148] versus 74% [114 of 154]). In their current practice, the groups were equally likely to have provided a newborn bag and mask ventilation, chest compressions, and resuscitation medications. Pediatricians were more likely than family physicians to have attempted to either intubate a newborn (20% [28 of 148] versus 10% [16 of 153]; P = .0495) or insert umbilical catheters (15% [22 of 148] versus 5% [8 of 153]; P = .005). Regardless of specialty, rural physicians were much more likely to report that they attended deliveries (61% [41 of 67] versus 15% [36 of 234]; P < .001). Among rural pediatricians attending deliveries, 44% (7 of 16) reported feeling inadequately prepared for at least one delivery in the past year. Few primary care pediatricians and family physicians provide newborn resuscitation after residency. For those who do attend deliveries, current training 5 provide insufficient preparation. Flexible, individualized residency curricula could target intensive resuscitation training to individuals who plan to practice in rural areas and/or attend deliveries after graduation.

A Neonatal Resuscitation Curriculum in Malawi, Africa: Did It Change In-Hospital Mortality?

Objective. The WHO estimates that 99% of the 3.8 million neonatal deaths occur in developing countries. Neonatal resuscitation training was implemented in Namitete, Malawi. The study's objective was to evaluate the training's impact on hospital staff and neonatal mortality rates. Study Design. Pre-/postcurricular surveys of trainee attitude, knowledge, and skills were analyzed. An observational, longitudinal study of secondary data assessed neonatal mortality. Result. All trainees' (n = 18) outcomes improved, (P = 0.02). Neonatal mortality did not change. There were 3449 births preintervention, 3515 postintervention. Neonatal mortality was 20.9 deaths per 1000 live births preintervention and 21.9/1000 postintervention, (P = 0.86). Conclusion. Short-term pre-/postintervention evaluations frequently reveal positive results, as ours did. Short-term pre- and postintervention evaluations should be interpreted cautiously. Whenever possible, clinical outcomes such as in-hospital mortality should be additionally assessed. More rigorous evaluation strategies should be applied to training programs requiring longitudinal relationships with international community partners.

The evolution of neonatal resuscitation training

The evolution of neonatal resuscitation training

High-fidelity simulator technology may not be superior to traditional low-fidelity equipment for neonatal resuscitation training

Despite completing accredited resuscitation training, neonatal trainees often feel unprepared to deal with real-life clinical emergencies. High-fidelity simulator (HFS) technology offers the potential of recreating a realistic stressful clinical environment to aid training and evaluation. To date, there are limited data examining the physiological impact of this training modality in comparison to less costly alternatives. The objective of this study was to compare the effects of low-fidelity simulator (LFS) versus HFS technology on performance levels, objective and subjective measures of stress in neonatal trainees. Sixteen neonatal fellows were invited to participate in a prospective randomized study. Subjects were divided into pairs and randomized to LFS or HFS for completion of scenario I. After an interval of 1 month, fellow teams crossed over to complete scenario II using the alternative simulator technology. Technical and non-technical skills were assessed using validated resuscitation scoring tools. Participants recorded subjective stress at sequential time points before and after each simulation. Buccal cortisol was measured at each corresponding time point and comparison between HFS and LFS groups was made. The mean overall resuscitation performance score was 75.8%±10, but there was no difference in performance between HFS and LFS groups. There was also no significant difference in non-technical skills performance between groups. Salivary cortisol increased over the duration of the simulated experience, but there were no differences between the two groups (P=0.001, two-way repeated measures analysis of variance). We also identified changes in subjective measures of stress (P<0.001, analysis of variance) over time, but again there were no differences between groups. Simulated neonatal resuscitations induce a significant stress response in neonatal trainees; however, we were unable to identify any difference in stress measures between HFS and LFS. These data suggest that HFS technology offers no additional stress-inducing benefit.

Reduced perinatal mortality following enhanced training of birth attendants in the Democratic Republic of Congo: a time-dependent effect

BackgroundIn many developing countries, the majority of births are attended by traditional birth attendants, who lack formal training in neonatal resuscitation and other essential care required by the newly born infant. In these countries, the major causes of neonatal mortality are birth asphyxia, infection, and low-birth-weight/prematurity. Death from these causes is potentially modifiable using low-cost interventions, including neonatal resuscitation training. The purpose of this study was to evaluate the effect on perinatal mortality of training birth attendants in a rural area of the Democratic Republic of Congo (DRC) using two established programs.MethodsThis study, a secondary analysis of DRC-specific data collected during a multi-country study, was conducted in two phases. The effect of training using the WHO Essential Newborn Care (ENC) program was evaluated using an active baseline design, followed by a cluster randomized trial of training using an adaptation of a neonatal resuscitation program (NRP). The perinatal mortality rates before ENC, after ENC training, and after randomization to additional NRP training or continued care were compared. In addition, the influence of time following resuscitation training was investigated by examining change in perinatal mortality during sequential three-month increments following ENC training.ResultsMore than two-thirds of deliveries were attended by traditional birth attendants and occurred in homes; these proportions decreased after ENC training. There was no apparent decline in perinatal mortality when the outcome of all deliveries prior to ENC training was compared to those after ENC but before NRP training. However, there was a gradual but significant decline in perinatal mortality during the year following ENC training (RR 0.73; 95% CI: 0.56-0.96), which was independently associated with time following training. The decline was attributable to a decline in early neonatal mortality. NRP training had no demonstrable effect on early neonatal mortality.ConclusionTraining DRC birth attendants using the ENC program reduces perinatal mortality. However, a period of utilization and re-enforcement of training may be necessary before a decline in mortality occurs. ENC training has the potential to be a low cost, high impact intervention in developing countries.Trial registrationThis trial has been registered at http://www.clinicaltrials.gov (identifier NCT00136708).

ENC training reduces perinatal mortality in Karnataka, India

Objective: To evaluate the effect of World Health Organization Essential Newborn Care course and the American Academy of Pediatrics Neonatal Resuscitation Program training on perinatal mortality in rural India. Methods: This study was part of a multi-country prospective, community-based cluster randomized controlled trial. Birth, 7-day and 28-day neonatal outcomes for all women with pregnancies greater than 28 weeks in the 26 study communities in Karnataka, India were included. Mortality rates pre- and post-Essential Newborn Care training were collected prospectively and then communities randomized to either receive neonatal resuscitation or refresher newborn care training in the control clusters. Results: Consent was obtained on 99% of the 25,096 births. Perinatal mortality for infants ≥500 g decreased from 52 to 36/1000 after newborn care training (RR 0.7; 95% CI 0.5, 0.9); stillbirth decreased from 23 to 14/1000 (RR 0.62; 95% CI 0.46, 0.83) and early neonatal mortality decreased from 29 to 22/1000 (RR 0.74; 95% CI 0.53, 1.03). Mortality was not reduced further with resuscitation training. Conclusions: Using a pre–post design, World Health Organization Essential Newborn Care community birth attendant training resulted in a significant reduction in perinatal mortality. In low-resource settings, the newborn care training package appears to be an effective intervention to decrease perinatal mortality.

The experience of the eleanor bradley fellow

The Eleanor Bradley Fellowship was established to enable specialist trainees from the UK to gain valuable obstetric experience in a resource limited setting. Set up in 2008, by the RCOG...

Stayin’ alive: The 2010 Heart and Stroke Foundation of Canada/American Heart Association resuscitation guidelines for newborns and older children

Five years have transpired since the most recent set of paediatric and neonatal resuscitation guidelines were jointly released by the Heart and Stroke Foundation of Canada (HSFC) and the American Heart Association. The recent publication of the 2010 resuscitation guidelines (1–3) prompts the following questions: What process led to the creation of the guidelines? What is new since 2005? What is our role in implementation? Guideline development has evolved from using consensus of experts, to the use of an evidence-based approach. Starting in 2000, the International Liaison Committee on Resuscitation (ILCOR), consisting of resuscitation councils from around the world (including the HSFC), has conducted regular systematic reviews of the resuscitation literature. These reviews resulted in the Consensus on Science and Treatment Recommendations (CoSTR). After the release of ILCOR’s 2005 CoSTR document, the paediatric and neonatal task forces reconvened, with international (including Canadian) representation. Each task force identified key questions requiring evidence evaluation, and assigned each question to two or more international resuscitation experts. After a rigorous literature search, relevant articles were independently identified, analyzed and graded by each worksheet author. With the assistance of an evidence evaluation expert, the scientific information surrounding a specific question was summarized and treatment recommendations were drafted based on this summary. The worksheet summaries (without treatment recommendations) were made available to the wider scientific community through the ILCOR website. Each worksheet author then presented his/her findings one final time to the paediatric or neonatal task forces, who debated and finalized the CoSTR statements (published in October 2010 [4,5]). Since that time, regional resuscitation councils (such as the HSFC and American Heart Association) have released their own resuscitation guidelines that have contextualized the CoSTR documents for their respective health care systems. A significant challenge for the world’s paediatric and neonatal resuscitation community continues to be the paucity of high-quality studies in the basic science, clinical and educational domains. Many resuscitation science recommendations are based on extrapolation from adult (human) studies or even animal data, whereas educational science largely consists of low-level studies of learner outcomes rather than patient outcomes. There is a pressing need for further study regarding how best to translate resuscitation science into practice, and how best to improve knowledge acquisition and retention by both lay rescuers and health care professionals over time. Studies are needed to compare traditional instructor-led courses with newer innovative approaches to teaching including Internet- and computer-based training, and low- or high-fidelity simulation. The rapid attrition of cognitive and technical skills within months of initial instruction suggests that we need to consider other approaches to continuing education, potentially including more frequent refresher courses, training sessions or simulations. The introduction of simulation and debriefing to neonatal resuscitation training will result in substantial changes to Neonatal Resuscitation Program (NRP) courses, presenting new challenges for our instructors and learners. These new methodologies will help us recognize the importance of teamwork competencies, and individual knowledge, skills and behaviours. Fortunately, the clinical science recommendations reinforce and build on practices introduced to Canada in 2006 (6), and will require relatively minor modifications. Outside the newborn population, clearer, simpler and more consistent messaging to the public regarding how to provide cardiopulmonary resuscitation (CPR) to individuals of all ages will hopefully ensure that bystanders act promptly, in contrast to the majority of out-of-hospital cardiac arrests in Canada, where no intervention is provided by lay rescuers. Starting the first cycle of CPR with chest compressions (chest compressions, airway, breathing), as opposed to the traditional order (airway, breathing, chest compressions) will ensure that rescuers immediately ‘do something (ie, at least chest compressions) as opposed to doing nothing’ for all cardiac arrest victims. This will maximize coronary perfusion and delay the provision of rescue breaths by only a few seconds. The challenge for paediatric and neonatal health care providers is to recognize our collective role and responsibility in optimizing resuscitative care for Canada’s infants and children. Although maintaining up-to-date CPR certification and/or NRP registration is an essential first step, our role extends to advocating CPR education for our own children and families, and getting the “stayin’ alive” message out to the public through our patients, their families and the community. It is time for us, as paediatricians, to approach paediatric cardiac arrest as a preventable disease, in the same way that we successfully advanced seatbelt and bicycle helmet education programs. Similarly, perinatal teams should view newborn compromise as predictable in many circumstances and, therefore, assess risk and prepare for resuscitation before every delivery. Finally, it is incumbent on us to cultivate resuscitation-based scientific research to fill the knowledge gaps in basic, clinical and educational science, and inform future CoSTR cycles.

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.

Impact of training and equipment for neonatal resuscitation in Zambia

British Journal of MidwiferyVol. 19, No. 3 InternationalImpact of training and equipment for neonatal resuscitation in ZambiaTeaching traditional birth attendants techniques for neonatal resuscitation led to a net reduction of 18 deaths per 1000 live births in rural Zambia—a reduction of almost 50%.Jane BainbridgeJane BainbridgeSearch for more papers by this authorJane BainbridgePublished Online:16 Aug 2013https://doi.org/10.12968/bjom.2011.19.3.191AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 1 March 2011Volume 19Issue 3ISSN (print): 0969-4900ISSN (online): 2052-4307 Metrics History Published online 16 August 2013 Published in print 1 March 2011 Information© MA Healthcare LimitedPDF download

An alternative strategy for perinatal verbal autopsy coding: single versus multiple coders

To determine the comparability between cause of death (COD) by a single physician coder and a two-physician panel, using verbal autopsy. The study was conducted between May 2007 and June 2008. Within a week of a perinatal death in 38 rural remote communities in Guatemala, the Democratic Republic of Congo, Zambia and Pakistan, VA questionnaires were completed. Two independent physicians, unaware of the others decisions, assigned an underlying COD, in accordance with the causes listed in the chapter headings of the International classification diseases and related health problems, 10th revision (ICD-10). Cohen's kappa statistic was used to assess level of agreement between physician coders. There were 9461 births during the study period; 252 deaths met study enrolment criteria and underwent verbal autopsy. Physicians assigned the same COD for 75% of stillbirths (SB) (K = 0.69; 95% confidence interval: 0.61-0.78) and 82% early neonatal deaths (END) (K = 0.75; 95% confidence interval: 0.65-0.84). The patterns and proportion of SBs and ENDs determined by the physician coders were very similar compared to causes individually assigned by each physician. Similarly, rank order of the top five causes of SB and END was identical for each physician. This study raises important questions about the utility of a system of multiple coders that is currently widely accepted and speculates that a single physician coder may be an effective and economical alternative to VA programmes that use traditional two-physician panels to assign COD.

Historical Perspectives

In 1960, Cathy Cropley graduated from the University of Washington, Phi Beta Kappa key in hand, and began a career that was to cover a time span from when nurses were considered functionaries to the time they became true partners in developing units and providing care. Nowhere is this truer than in the world of the neonatal intensive care unit (NICU). Cathy's first job was as a staff nurse in obstetrics at the University Hospital of the University of Washington in Seattle. One year later, she was appointed head nurse of the newborn nursery (there was no NICU in the hospital at that time). In 1962, Tim Oliver, MD, one of the pioneers in neonatology, joined the faculty of the University with the goal of creating a NICU and a new Division of Neonatology. Cathy was selected to be his head nurse. Because there were very few NICUs at that time, Cathy and the rest of the staff nurses had no familiarity with the type of unit they were going to develop. As Dr Oliver began to mold the unit and teach the nurses and housestaff …

1282 Heart Rate Assessment, Right on Time (Heart). Effects of Training Heart Rate Assessment in Neonatal Resuscitation: Performance, Confidence, Stress Level

Background and aims: Stethoscopic heart rate estimation has previously been shown to be inaccurate in manikin models. We aimed to determine whether training could improve accuracy, and determine any association with perceived stress and confidence levels, in paediatric specialist registrars (SpRs). Methods: Prospective, simulation study involving an intervention group of 17 Paed SpRs and 22 controls (paediatric, anaesthesiology, obstetric SpRs and midwives without training intervention) assessing HR by stethoscope in a VitalSim© manikin. HR was randomly set at 40,50,70 and 80 BPM. Absolute HR was assessed in the first scenario, HR range ( 100) during bag and mask ventilation in second scenario and after three cycles of compressions and ventilation in third scenario. This was repeated 2 weeks after a training intervention. Results: There was a non-significant increase in accurate HR assessment in the first scenario in the intervention group relative to the control group (17.7%vs.9.1%, OR1.7,95%CI0.4-6.4), and non-significant shorter time to determine HR in the second scenario in the intervention group as compared to the control group (Beta-.03, P=0.094). Stress level was significantly lower after training in intervention and control group (P< 0.05). There was a trend towards higher level of confidence in intervention compared to the control group (Beta0.27, P=0.092). Lower stress and higher confidence level were associated with shorter time to determine HR (Beta0.59, P=0.045, Beta- 0.38, P=0.029, respectively). Conclusions: Training in neonatal resuscitation was not associated with significant improvement in performance, although there were trends toward higher accuracy and shorter time to determine HR. Confidence and stress level were associated with shorter time to determine HR.

Newborn Care Training of Midwives and Neonatal and Perinatal Mortality Rates in a Developing Country

This study was designed to test the hypothesis that 2 training programs would reduce incrementally 7-day neonatal mortality rates for low-risk institutional deliveries. Using a train-the-trainer model, certified research midwives sequentially trained the midwives who performed deliveries in low-risk, first-level, urban, community health clinics in 2 cities in Zambia in the protocol and data collection, in the World Health Organization Essential Newborn Care (ENC) course (universal precautions and cleanliness, routine neonatal care, resuscitation, thermoregulation, breastfeeding, kangaroo care, care of small infants, and common illnesses), and in the American Academy of Pediatrics Neonatal Resuscitation Program (in-depth basic resuscitation). Data were collected during 3 periods, after implementation of each training course. A total of 71 689 neonates were enrolled in the 3 study periods. All-cause, 7-day neonatal mortality rates decreased from 11.5 deaths per 1000 live births to 6.8 deaths per 1000 live births after ENC training (relative risk: 0.59 [95% confidence interval: 0.48-0.77]; P < .001), because of decreases in rates of deaths attributable to birth asphyxia and infection. Perinatal mortality rates but not stillbirth rates decreased. The 7-day neonatal mortality rate was decreased further after Neonatal Resuscitation Program training, after correction for loss to follow-up monitoring. ENC training for midwives reduced 7-day neonatal mortality rates in low-risk clinics. Additional in-depth basic training in neonatal resuscitation may reduce mortality rates further.

Neonatal Resuscitation: A Global Challenge

Two studies of neonatal care appear in this issue of Pediatrics : “Newborn Care Training for Midwives and Neonatal and Perinatal Mortality Rates in a Developing Country”1 and “High Mortality Rates of Very Low Birth Weight Infants in Developing Countries Despite Training.”2 Results of the first study of 71 689 infants born in a hospital setting in Zambia indicates that an education program focused on cleanliness, thermal protection, neonatal resuscitation, early breastfeeding, skin-to-skin care with the mother, care of the small infant, recognition of infant danger signs, and initial management effectively lowered the early neonatal mortality rate from 11.5 in 1000 to 6.8 in 1000 live births. The addition of enhanced neonatal resuscitation training was associated with further reduction of the 7-day neonatal mortality rate but required substantial statistical modeling to account for changing follow-up rates throughout the course of this facility-based study.1 In the second article, Carlo et al2 report on the outcome of 500- to 1499-g infants in a 6-country, 7-site study of the same educational intervention conducted in rural communities in which most deliveries occurred at home or in first-level facilities. Neither the simple newborn care package with resuscitation nor the additional neonatal resuscitation training was associated with a decrease in the 7-day mortality rate. … Address correspondence to William Keenan, MD, Department of Pediatrics, Saint Louis University, 1465 S Grand Blvd, St Louis, MO 63119. E-mail: keenanwj{at}slu.edu

952 Knowledge Gained by Residents After Neonatal Resuscitation Program Course: Comparison Among Pediatrics, Anesthesia and Gynecology

Objective: Neonatal resuscitation program (NRP) course is effective in improving knowledge in participants; however, its efficacy in relation to the specialty training of the attendants is lacking. We assessed the effectiveness of the NRP course in the knowledge gained by residents in pediatrics, anesthesiology and gynecology. Methods: A 71-item questionnaire derived from the standard test contained in the American Heart Association and American Academy of Pediatrics Neonatal Resuscitation Manual was administered to residents in pediatrics, anesthesiology and gynecology before and after the course. Results: A total of 124 residents attended 4 courses from 2006 to 2009: 65 of them were training in pediatrics, 32 in anesthesia, 27 in gynecology. The percentages of correct answers significantly improved from before (61.07 ± 0.92%) to after the course (86.24 ± 0.52%; p < 0.001) in all the three groups. However, in the pretest as well as in the posttest, pediatrics and anesthesiology residents obtained higher scores than gynecology residents (p < 0.001). Conclusions: Residents significantly improved their knowledge attainment following participation in the NRP course; however, their performance changed with the different background training. These aspects need to be considered for improving effective strategies in neonatal resuscitation training.

The development and initiation of the NSW Department of Health interprofessional Fetal welfare Obstetric emergency Neonatal resuscitation Training project

The Fetal Welfare Obstetric emergency Neonatal resuscitation Training (FONT) project was initiated on a background of rising notifications of adverse events in NSW maternity units, the significant proportion of which were related to fetal welfare assessment. The aim of the study is to describe the development and introduction of the NSW state-wide interprofessional FONT project. Following development and risk assessment, FONT was launched in February 2008. The project consists of an online component and two face-to-face training days to be completed each 3 years; the first day for fetal welfare assessment and the second for obstetric and newborn emergencies. Eight, 2-day training sessions were conducted throughout NSW for FONT trainers. Each trainer underwent pre- and post-testing for changes in knowledge of fetal welfare assessment. The 2005-2008 NSW adverse event report numbers were assessed. From 20 February to 17 April 2008, 240 trainers had been trained in fetal welfare assessment, and by the end of 2008 these trainers had trained 954 clinicians. There were significant improvements in the interpretation and management planning of electronic fetal heart rate patterns following training. Analysis of Severity Assessment Codes 1 and 2 showed no significant trend in the number of notifications for adverse events related to fetal welfare assessment. In the first 11 months, 25% of the state's maternity practitioners had received training in the first stage of the FONT project. The FONT project has shown short-term improvements in learning and communication skills and in the participants of the project.

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.