Neonatal Resuscitation Training Research Articles

The impact of supply-side and demand-side interventions on use of antenatal and maternal services in western Kenya: a qualitative study

BackgroundAntenatal care (ANC) and delivery by skilled providers have been well recognized as effective strategies to prevent maternal and neonatal mortality. ANC and delivery services at health facilities, however, have been underutilized in Kenya. One potential strategy to increase the demand for ANC services is to provide health interventions as incentives for pregnant women. In 2013, an integrated ANC program was implemented in western Kenya to promote ANC visits by addressing both supply- and demand-side factors. Supply-side interventions included nurse training and supplies for obstetric emergencies and neonatal resuscitation. Demand-side interventions included SMS text messages with appointment reminders and educational contents, group education sessions, and vouchers to purchase health products.MethodsTo explore pregnant mothers’ experiences with the intervention, ANC visits, and delivery, we conducted focus group discussions (FGDs) at pre- and post-intervention. A total of 19 FGDs were held with pregnant mothers, nurses, and community health workers (CHWs) during the two assessment periods. We performed thematic analyses to highlight study participants’ perceptions and experiences.ResultsFGD data revealed that pregnant women perceived the risks of home-based delivery, recognized the benefits of facility-based delivery, and were motivated by the incentives to seek care despite barriers to care that included poverty, lack of transport, and poor treatment by nurses. Nurses also perceived the value of incentives to attract women to care but described obstacles to providing health care such as overwork, low pay, inadequate supplies and equipment, and insufficient staff. CHWs identified the utility and limitations of text messages for health education.ConclusionsFuture interventions should ensure that adequate workforce, training, and supplies are in place to respond to increased demand for maternal and child health services stimulated by incentive programs.

Video Laryngoscopy Improves the Success of Neonatal Tracheal Intubation for Novices but Not for Experienced Medical Staff.

Background: There is limited evidence on the use of video laryngoscopy (VL) in neonatal tracheal intubation (NTI) during neonatal resuscitation. In this study, we aimed to compare the difference between direct laryngoscopy (DL) and VL in NTI of trainees during neonatal resuscitation training.Materials and Methods: A prospective observational study was conducted during a neonatal resuscitation training course to examine three circumstances: NTI by experienced medical staff (EMS) and less-experienced medical staff (LEMS) in a neonatal resuscitation scenario; NTI by EMS and LEMS with an ongoing chest compression; and NTI by midwives who were novices in the procedure. The trainees were given scenarios or were shown demonstrations on newborn simulation manikins and were required to perform an NTI on a simulation manikin using DL and/or VL. The mean intubation time and success rate of intubation were measured.Results: The mean NTI time for EMS using VL (24.1 ± 7.2 s) was significantly longer than that using DL intubation (18.1 ± 6.9 s, P < 0.001), whereas there was no significant difference between using VL and DL for LEMS. EMS spent slightly less time on NTI than did LEMS using both VL and DL, but there were no statistically significant differences (both p > 0.05). The NTI success rate for EMS using VL (48.0%, 12/25) was significantly lower than that using DL (88.0%, 22/25, P = 0.004), while the NTI success rate for LEMS using VL (68.2%, 15/22 vs. 40.9%, 9/22) was higher than that using DL, but there was no statistical significance. When NTI was required with ongoing chest compressions, there was no significant difference in the mean NTI time and success rate between using VL and DL for EMS or LEMS. In the group of midwives who were novices in NTI, after they watched a demonstration teaching NTI, the intubation time using VL (19.6 ± 9.0 s) was significantly shorter than that using DL (28.0 ± 6.7 s, P < 0.001). The success rate of NTI using VL was significantly higher (96.2%; 25/26) than that using DL (69.2%; 18/26).Conclusion: The video laryngoscopy could be an effective training tool for inexperienced staff in developing the skill of tracheal intubation.

Suctioning at birth showed low adherence to official recommendations in a low-resource setting.

Education on neonatal resuscitation is most urgent in settings with poor access to intrapartum obstetric care, where immediate postnatal mortality can be reduced by 30% with basic training in neonatal resuscitation. Management of newborns at birth includes different interventions based on progressive steps (initial steps, ventilation, chest compressions, and medications).

EHBB/mHBS-DHIS2: Mobile Virtual Reality Provider Training in Helping Babies Breathe®

Background: Intrapartum asphyxia accounts for the deaths of around 280,000 babies per year. Helping Babies Breathe® (HBB) is an evidence-based global neonatal resuscitation training program. HBB utilizes an in-person dissemination model. However, there are challenges to maintaining training fidelity, data collection, and continuous learning and improvement. Aim: The objective is to develop and test an integrated mobile virtual reality (VR) simulation application (eHBB) and data collection tool (mHBS) for healthcare worker training in neonatal resuscitation. Methods: eHBB, a VR training application developed on the Unreal™ platform and accessible on mobile devices …

Impact of Repeat Simulated Neonatal Resuscitation Training on Neonatal Resuscitation Program Algorithm Adherence in a Community Hospital

Impact of Repeat Simulated Neonatal Resuscitation Training on Neonatal Resuscitation Program Algorithm Adherence in a Community Hospital

Effect of simulation on the development of cognitive skills of the first aid and emergency aid students in neonatal resuscitation

Purpose: This study was conducted to search the effect of simulation on the development of cognitive skills of the first aid and emergency students in neonatal resuscitation. Materials and Methods: The study, which was planned as a randomized controlled, experimental study, was performed between with 60 students studying in the second year of First Aid and Emergency Programme. The students were divided into two groups as experimental and control groups. Prior to the study, the students were provided with an information form and the Scale of Problem Solving Inventory (PSI) and the Neonatal Resuscitation Knowledge Exam were conducted on both of the groups to determine the individual characteristics of the students. The students in the experimental group were trained with the “Scenario-Based Simulation Application” while the control group was given a theoretical lecture on “Neonatal Resuscitation” by the researcher. After two weeks, the final tests were applied to both groups. Result: The averages of the student grades from the Neonatal Resuscitation examination after the training revealed a difference between the groups and that simulation group got higher grades, and the averages of the student groups from the PSI determined that the total grade averages of trust, personal control and total score were significantly different. Conclusion: The use of simulation in the neonatal resuscitation training of the First Aid and Emergency students is effective and it increases the knowledge score averages and problem-solving skills of the student.

Use of web-based game in neonatal resuscitation - is it effective?

BackgroundKnowledge and skills decline within months post simulation-based training in neonatal resuscitation. To empower ‘Millennial’ learners to take control of their own learning, a single-player, unguided web-based Neonatal Resuscitation Game was designed. The present study investigates the effectiveness of the game on retention of resuscitation knowledge and skills.MethodsThe study evaluated 162 healthcare professionals who attended simulation-based training in neonatal resuscitation. Following standard simulation-based training, participants were assigned to either a gaming group (Gamers) with access to the web-based Neonatal Resuscitation Game or a control group (Controls) with no access to the game. Although Gamers were given access, game utilization was completely voluntary and at will. Some Gamers chose to utilize the web-based game (Players) and others did not (Non-players). Knowledge and skills in neonatal resuscitation were assessed upon completion of training and 6 months post-training using a multiple-choice question test and a manikin-based skills test. Changes in scores were compared statistically between Gamers vs Controls, Players vs Controls, and Players vs Controls + Non-players using two-sample t-tests.ResultsAt the final assessment, declines in knowledge scores were seen in all groups. Mean change from baseline in knowledge and skill performance scores at 6 months, adjusted for baseline skill performance and MCQ test scores, did not differ significantly between Players vs Controls and Players vs Controls + Non-players.ConclusionThe web-based game in its current format may not be effective in facilitating retention of knowledge and technical skills in neonatal resuscitation.

Baby Warmer to Improve Neonatal Resuscitation Training

Objectives To enhance realism in neonatal simulations, a modification to a commercial infant warmer was desired. The ideal modification must allow use of existing controls and alarm functions, as well as work with any manikin to display temperature, and to provide feedback to learners about patient condition. Methods A Panda BNT-1000 radiant baby warmer was used for this warmer unit modification. The radiant warmer’s heat lamps were disconnected from the control board. Then the 120 VAC heat lamp output was connected to a low voltage (12VDC 2A) transformer to power LED lights. Two parallel strips of LEDs, with a color-temperature of 2000K, were run along the parabolic reflector. Ordinarily, the front temperature sensor is controlled by a thermistor. We internally disconnected the thermistor, and replaced it with a fixed resistor in series with a correctly proportioned potentiometer. This modification allows the front-panel temperature readout to be altered without any actual change in temperature. Results The resistance of the thermistor at physiologic temperature was 12.6K-Ohm. A 10K-Ohm resistor and a 10K-Ohm potentiometer applied in series across this terminal provides controllable temperature readouts on the front panel, producing a fully functional-appearing radiant warmer with standard operation and alarms. The improved warmer design allows simulation of hypo- and hyper-thermic conditions that previously could not be accomplished. Conclusion Color-temperature matched LED light strips are a visually similar alternative to thermal heating elements in an infant warmer. User control (via potentiometer) of the front-panel temperature display allows training of temperature physiology while preserving system alarms. Additionally, simulation equipment will no longer experience damaging heat or UV exposure.

Cohort study of neonatal resuscitation skill retention in frontline healthcare facilities in Bihar, India, after PRONTO simulation training

BackgroundUse of simulation in neonatal resuscitation (NR) training programmes has increased throughout low-income and middle-income countries. Many of such programmes have demonstrated a positive impact on NR knowledge and skill...

Simulation in Neonatal Resuscitation.

Approximately 1 in 10 newborns will require basic resuscitation interventions at birth. Some infants progress to require more advanced measures including the provision of positive pressure ventilation, chest compressions, intubation and administration of volume/cardiac medications. Although advanced resuscitation is infrequent, it is crucial that personnel adequately trained in these techniques are available to provide such resuscitative measures. In 2000, Louis Halmalek et al. called for a “New Paradigm in Pediatric Medical Education: Teaching Neonatal Resuscitation in a Simulated Delivery Room Environment.” This was one of the first articles to highlight simulation as a method of teaching newborn resuscitation. The last decades have seen an exponential growth in the area of simulation in newborn care, in particular in newborn resuscitation and stabilization. Simulation is best defined as an instructional strategy “used to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner.” Simulation training has now become an important point of how we structure training and deliver improved healthcare to patients. Some of the key aspects of simulation training include feedback, deliberate practice, outcome measurement, retention of skills and curriculum integration. The term “Train to win” is often used in sporting parlance to define how great teams succeed. The major difference between sports teams is that generally their game day comes once a week, whereas in newborn resuscitation every day is potentially “game day.” In this review we aim to summarize the current evidence on the use of simulation based education and training in neonatal resuscitation, with particular emphasis on the evidence supporting its effectiveness. We will also highlight recent advances in the development of simulation based medical education in the context of newborn resuscitation to ensure we “train to win.”

AB003. System development of telesimulation for neonatal resuscitation and NICU telemedicine

: Since about half of deliveries are carried out in local obstetric clinics in Japan, instructors are expected to improve resuscitation skills of workers engaged in delivery in the community. In this study, we developed a simulation tool for the remote support of neonatal resuscitation applicable for telemedicine. We developed seven simulation-based education tools: (I) stethoscope with a built-in speaker, (II) simulated pulse oximeter (iOS application operated using an iPad), (II) iPhone iOS application for wireless operation of (I) and (II), (IV) compact camera for video recording of resuscitation training, and (V) iPad for debriefing of training. In addition, (VI) a bag valve mask-equipped atmospheric pressure sensor and (VII) chest-compression monitoring-sensor were developed for remote evaluation of the reliability of resuscitation techniques of trainees. All these tools were wireless-linked through Wi-Fi and Bluetooth to prepare a remote support system. We used this system in neonatal resuscitation training in Kingdom of Bhutan. We operated this system from Japan and could be carried out without equipment failure. There was no two-way communication time-lag and facilitation by an instructor from a remote location was mostly the same as in a normal session. The instructor could easily evaluate the skills of the trainees through a streaming video and monitoring index. It was suggested that the system contributes to cooperation between a tertiary medical facility and local delivery facilities. Since the real cost was low, about 300 US dollars excluding the cost of the mobile device, its introduction may serve as an important social foundation for regional cooperation in not only Japan but also developing countries worldwide. If (VI)-(VII) of the system described above and communication environment can be prepared, remote support of neonatal resuscitation in a clinical practice may be possible.

Neonatal resuscitation training for midwives in Australia: A discussion of current practice

BackgroundMore than 300,000 babies are born in Australia each year, with almost 20% of newborns requiring some form of neonatal resuscitation at birth. The most common first responders to a neonatal resuscitation emergency are midwives. While the Australian and New Zealand Council on Resuscitation guides midwives’ practice during a neonatal resuscitation, each state and territory uses varying strategies to train and assess midwives proficiency in neonatal resuscitation. AimTo examine the neonatal resuscitation training requirements for midwives and raise awareness for the lack of consistency in training in Australia. DiscussionA significant variation was found in the teaching methods and frequency of training for neonatal resuscitation across Australia. Neonatal resuscitation is mandated through a state-wide guideline or policy in only four of the states with seven formal neonatal resuscitation training programs used across seven states and territories. Although a multi-modal approach to learning is present in all of the programs, the combination of teaching methods differ. Conclusion and RecommendationsA standardised, evidence-based training program is required to ensure consistency in training for midwives in Australia. Multi-modal learning is common across all current training programs; however, the best combination of multi-modal teaching methods needs to be determined. Neonatal resuscitation training needs to occur at least annually, as recommended by the Australian and New Zealand Council on Resuscitation.

A survey of emergency medical services personnel who attended the neonatal cardio-pulmonary resuscitation training course

A survey of emergency medical services personnel who attended the neonatal cardio-pulmonary resuscitation training course

Influence of Neonatal Resuscitation Training on Practice of Community Health Extension Workers in Managing Asphyxiated Newborns in Rural Nigeria: A Qualitative Study.

Birth asphyxia is a global health burden, and effective neonatal resuscitation could reduce the burden of deaths. Providing a suitable newborn resuscitation care will depend on the availability of an effective skilled health worker, who is competent in neonatal resuscitation. The study explores and assesses the effect of neonatal resuscitation training and retention of knowledge and skills in the management of asphyxiated newborns in rural Nigeria. This study used a narrative analysis technique to analyze data from a semistructured, individual interview. Data were analyzed using ATLAS.ti 8 qualitative software and applying the principle of thematic analysis. There was a considerable retention of knowledge and ability to practice the procedure even though some equipment was not available. Proficiency in neonatal resuscitation is an essential intervention for the survival of newborns and infants. Therefore, execution of neonatal resuscitation training program in rural communities can further improve knowledge and skills of community birth attendants in Nigeria.

A targeted systematic review of cost analyses for implementation of simulation-based education in healthcare.

Over the past two decades, there has been an increase in the use of simulation-based education for training healthcare providers in technical and non-technical skills. Simulation education and research programs have mostly focused on the impact on clinical knowledge and improvement of technical skills rather than on cost. To study and characterize existing evidence to inform multi-stakeholder investment decisions, we performed a systematic review of the literature on costs in simulation-based education in medicine in general and in neonatal resuscitation as a particular focus. We conducted a systematic literature search of the PubMed database using two targeted queries. The first searched for cost analyses of healthcare simulation-based education more broadly, and the second was more narrowly focused on cost analyses of neonatal resuscitation training. The more general query identified 47 qualified articles. The most common specialties for education interventions were surgery (51%); obstetrics, gynecology, or pediatrics (11%); medicine, nursing, or medical school (11%); and urology (9%), accounting for over 80% of articles. The neonatal resuscitation query identified five qualified articles. The two queries identified seven large-scale training implementation studies, one in the United States and six in low-income countries. There were two articles each from Tanzania and India and one article each from Zambia and Ghana. Methods, definitions, and reported estimates varied across articles, implying interpretation, comparison, and generalization of program effects are challenging. More work is needed to understand the costs, processes, and outcomes likely to make simulation-based education programs cost-effective and scalable. To optimize return on investments in training, assessing resource requirements, associated costs, and subsequent outcomes can inform stakeholders about the potential sustainability of SBE programs. Healthcare stakeholders and decision makers will benefit from more transparent, consistent, rigorous, and explicit assessments of simulation-based education program development and implementation costs in low- and high-income countries.

Preparedness of primary health care workers and audit of primary health centres for newborn resuscitation in Port Harcourt, Rivers State, Southern Nigeria.

Introduction:Nigeria still has high newborn deaths and birth asphyxia remains a major cause. Birth attendants´ readiness to perform newborn resuscitation depends largely on their competence in basic resuscitation and availability of newborn resuscitation equipment to enable the various steps outlined in resuscitation guidelines to be applied quickly and appropriately. This study aimed to assess primary health care workers´ experience of neonatal resuscitation and audit primary health centres for availability of neonatal resuscitation equipment.Methods:this descriptive cross-sectional study surveyed 106 primary health care workers (22 doctors, 84 nurses) randomly selected from 28 Primary Health Centres to document their experiences in newborn resuscitation and appraise the centres for availability of newborn resuscitation equipment. Experience in newborn resuscitation was obtained using a semi-structured questionnaire and audit was with a Proforma following on-site facility visits. Data was analysed using SPSS v20 and displayed in tables and graphs.Results:all health care workers had resuscitated newborns but only 58(57.4%) had ever used a bag and mask, 53(50%) used stethoscopes and 19(17.9%) had resuscitation protocol in their facilities. Fifteen (53.6%) health centres had functional newborn-specific bag and masks, 11(39.3%) had suction machines and 5(25%) had empty oxygen cylinders.Conclusion:primary health care workers´ experience of newborn resuscitation is very limited and some primary health centres were grossly unequipped. Neonatal resuscitation training interventions and supplies of neonatal resuscitation equipment are urgently needed.

The RETAIN Simulation-Based Serious Game-A Review of the Literature.

Background: Each year, over 13 million babies worldwide need help to breathe at birth. While guidelines recommend the Neonatal Resuscitation Program course, medical errors remain common. Frequent simulation training and assessment is needed to address this competence gap; however, alternative approaches are needed to overcome barriers to access. The RETAIN (REsuscitation TrAINing) simulation-based serious game (Retain Labs Medical Inc., Edmonton, AB, Canada) may provide a solution to supplement traditional training. This paper aims to review the available evidence about RETAIN for improving neonatal resuscitation education. Method: Literature searches of PubMed, Google Scholar, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and EMBASE databases were performed to identify studies examining the RETAIN serious game for neonatal resuscitation training. All of the studies describing the RETAIN board game and computer game were included. Results: Three papers and one conference proceeding were identified. Two studies described the RETAIN board game, and two studies described the RETAIN computer game. RETAIN was reported as usable and clinically relevant. RETAIN also improved knowledge of neonatal resuscitation by 12% and functioned as a summative assessment. Further, performance on RETAIN was moderated by players’ self-reported mindset. Conclusion: RETAIN can be used for the training and assessment of experienced neonatal resuscitation providers. Further studies are needed to understand the effectiveness of RETAIN to (i) improve other cognitive and non-cognitive skills, (ii) in diverse populations of neonatal resuscitation providers, (iii) in comparison to current standard training approaches, and (iv) in improving clinical outcomes in the delivery room.

Educational efficacy of high-fidelity simulation in neonatal resuscitation training: a systematic review and meta-analysis

BackgroundThe training of neonatal resuscitation is an important part in the clinical teaching of neonatology. This study aimed to identify the educational efficacy of high-fidelity simulation compared with no simulation or low-fidelity simulation in neonatal resuscitation training.MethodsThe PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, Chinese databases (CBM, CNKI, WanFang, and Weipu), ScopeMed and Google Scholar were searched. The last search was updated on April 13, 2019. Studies that reported the role of high-fidelity simulation in neonatal resuscitation training were eligible for inclusion. For the quality evaluation, we used the Cochrane Risk of Bias tool for RCTs and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for non-RCTs. A standardized mean difference (SMD) with a 95% confidence interval (CI) was applied for the estimation of the pooled effects of RCTs.ResultsFifteen studies (10 RCTs and 5 single arm pre-post studies) were ultimately included. Performance bias existed in all RCTs because participant blinding to the simulator is impossible. The assessment of the risk of bias of single arm pre-post studies showed only one study was of high quality with a low risk of bias whereas four were of low quality with a serious risk of bias. The pooled results of single arm pre-post studies by meta-analysis showed a large benefit with high-fidelity simulation in skill performance (SMD 1.34; 95% CI 0.50–2.18). The meta-analysis of RCTs showed a large benefit in skill performance (SMD 1.63; 95% CI 0.49–2.77) and a moderate benefit in neonatal resuscitation knowledge (SMD 0.69; 95% CI 0.42–0.96) with high-fidelity simulation when compared with traditional training. Additionally, a moderate benefit in skill performance (SMD 0.64; 95% CI 0.06–1.21) and a small benefit was shown in knowledge (SMD 0.39; 95% CI 0.08–0.71) with high-fidelity simulation when compared with low-fidelity simulation.ConclusionsImprovements of efficacy were shown both in resuscitation knowledge and skill performance immediately after training. However, in current studies, the long-time retention of benefits is controversial, and these benefits may not transfer to the real-life situations.

Neonatal Resuscitation and Airway Simulation Training for Ethiopian Pediatrics Residents

Neonatal Resuscitation and Airway Simulation Training for Ethiopian Pediatrics Residents

Neonatal Resuscitation and Airway Simulation Training for Ethiopian Pediatrics Residents

Background: 2.6 million children worldwide died within the first month of life in 2016, with the highest mortality in Africa. Specifically in Ethiopia, the infant mortality rate in 2016 was 27.6/1000 live births. Current global newborn care programs focus on training health workers, such as nurse delivery attendants and midwives, in drying, warming, stimulation, and positive pressure ventilation (PPV). Though medical doctors learn critical thinking and teaching skills that would allow them to use and disseminate procedural knowledge in practice, they are not often …