Competence in neonatal resuscitation is acquired and maintained through accredited life support courses and short in-situ booster training sessions. To ensure effective knowledge and skills integration into practice, valid tools for assessing performance are essential. The aim of this scoping review was to identify all available tools assessing overall performance neonatal resuscitation and evaluate their reported validity evidence. In January 2024 and July 2025, MEDLINE, Embase, and the Cochrane Library were searched to identify studies describing assessment tools for neonatal resuscitation and their associated validity evidence. All study types describing neonatal resuscitation assessment tools for simulation and clinical practice were included. Two reviewers independently screened titles and abstract followed by full-text screening. Data were extracted using predefined forms. A total of 146 sources were included, identifying 82 unique assessment tools for neonatal resuscitation. The number of included items in these tools varied widely, ranging from 5 to 133 (median=22, IQR=15-36). Some form of validity evidence was reported for 73.2% of these tools. Most studies reported items from classical frameworks for validity evidence; however, only 30.0% reported more than two items of these frameworks. Contemporary frameworks for validity evidence, considered the preferred standard, were only (partly) applied in three studies. Multiple assessment tools for neonatal resuscitation have been reported, most lack proper validity evidence. There is a clear need for further research and development of a comprehensive, up-to-date, properly validated, and widely applicable assessment tool to support high-quality training, reliable assessment, and ultimately improve patient outcomes.

Escape room and high-fidelity clinical simulation in neonatal nursing education: A randomized clinical trial

Variation in optimal communication modes during neonatal resuscitation.

The mnemonic "MR SOPA" (Mask adjustment, Repositioning head/airway, Suctioning, Open mouth, Pressure increase and Alternative airway) facilitates remembering corrective steps when ventilation during neonatal resuscitation is inadequate. Here, we critically evaluate the scientific evidence for each step and appraise the usefulness of the mnemonic as a sequential guidance in airway management of newborn infants: Mask: Size and placement are crucial to minimize mask leak and airway obstruction. Firm top and flexible edges may help form a better seal, while mask shape seems to be less important. Two-person holding technique may optimize applied tidal volumes. Repositioning: A neutral head position in newborns may improve airway patency. Suctioning: Suctioning should be reserved for infants with perceived airway obstruction to reduce vagal stimulation or tissue damage. Open the mouth/airway: There is no data on opening the mouth per se. Airway maneuvers like chin lift and jaw thrust may improve airway patency. Pressure increase: Despite weak evidence, increased PIP of ≥25cmH2O may be necessary to overcome closed glottis and fluid-filled lungs in non-breathing infants but must be titrated carefully to preclude lung injury. Alternative airway: Nasopharyngeal tubes and laryngeal masks are valid options when face mask ventilation fails. Endotracheal intubation remains the gold standard but should be reserved for experienced staff. These statements are based on scarce and limited evidence, largely from preclinical or smaller clinical studies. There is no evidence for performing the MRSOPA steps in its original sequence. Thus, more rigorous studies are needed to substantiate nature, timing and order of the interventions.

How consistent are recent neonatal resuscitation guidelines?

Background: In South India, infant mortality rates are high, and nurses require advanced training to respond to infants in infant distress. Evidence shows that improved nurse competency in neonatal resuscitation (NNR) and the ability of students to recognize and respond to distressed infants have led to decreased infant mortality rates. Purpose: The purpose of this quality improvement project was to design and implement a simulated escape room to improve NNR outcomes among undergraduate students in South India. Methods: This quality improvement project used a quantitative descriptive design. Undergraduate nursing students from 6 schools in South India completed an asynchronous maternal–fetal nursing course followed by an in-person simulated NNR escape room. Two quantitative surveys were used for evaluation: the facilitator survey assessed students’ completion of NNR skills during the escape room, and the student survey measured perceptions of the escape room experience. Results: There was a measurable increase in knowledge retention on the infant distress portion of the posttest following participation in the escape room. Most student groups successfully completed the NNR sequence with minimal assistance, demonstrating improved NNR competency. Students reported that the activity enhanced their teamwork and collaboration skills in a clinical context. Both students and facilitators described the escape room as an enjoyable, engaging, and psychologically safe learning experience. Implications for Practice and Research: This article provides an overview of the quality improvement project in which an NNR escape room was implemented as an innovative learning activity for nursing students in South India.

ABSTRACT Objective To compare the predictive accuracy of selected umbilical artery (UA) pulsatility index (PI) reference charts for outcomes associated with placenta‐mediated fetal growth restriction (FGR). Methods This was a retrospective cohort study of individuals with a singleton pregnancy who underwent UA Doppler assessment ≥ 20 weeks' gestation between January 2012 and December 2022 at a single tertiary referral center, at which UA Doppler is measured routinely regardless of fetal size. Using 10 different UA‐PI reference charts, we compared the predictive accuracy of an abnormal UA‐PI (> 95 th percentile) for two primary outcomes that are considered specific and gestational‐age‐independent indicators of placenta‐mediated FGR: (1) late‐stage UA Doppler abnormalities (defined as absent or reversed end‐diastolic flow); and (2) maternal vascular malperfusion (MVM) on placental pathology. We also investigated the ability of these 10 charts to predict the secondary outcome of composite adverse perinatal outcome, defined as the presence of at least one of the following: stillbirth, 5‐min Apgar score < 7, UA pH < 7.1, need for neonatal resuscitation and/or admission to the neonatal intensive care unit. Generalized estimating equations were used to calculate the predictive accuracy of the UA‐PI reference charts, accounting for repeated measurements within the same patient. To identify the best‐performing reference chart, we ranked each chart based on its Youden index at the 95 th percentile cut‐off for UA‐PI for the two primary outcomes. Given the distinct phenotypes of early‐ and late‐onset FGR, we also performed an analysis stratified by gestational age at ultrasound examination (< 32 vs ≥ 32 weeks). Results A total of 15 841 patients, with 38 398 ultrasound examinations, were included in the analysis. The proportion of small‐for‐gestational‐age (SGA) fetuses classified as FGR based on an abnormal UA‐PI varied widely depending on which reference chart was applied, ranging from 2.2% to 25.7%. Similarly, the predictive accuracy of the 10 different reference charts for placenta‐mediated FGR outcomes differed considerably. The predictive performance for late‐stage UA Doppler abnormalities varied substantially across charts, with sensitivity ranging from 20.7% to 76.3% and specificity from 75.2% to 98.0%. Likewise, for the prediction of MVM on placental pathology, the sensitivity of the charts ranged from 6.8% to 42.0% and specificity from 77.5% to 98.6%. For most of the charts, sensitivity and specificity remained comparable between the overall cohort and gestational‐age subgroups. When ranked according to overall predictive performance for the two primary outcomes using the Youden index, the UA‐PI reference charts of Rahimi et al. , Drukker et al. and Flatley et al. demonstrated the best overall predictive accuracy. These same three charts retained the top performance ranking for the prediction of primary study outcomes in the subgroup of cases examined < 32 weeks. Conclusions We observed substantial variation among 10 UA‐PI reference charts in both the proportion of SGA fetuses classified as growth restricted and the predictive accuracy of each chart for outcomes considered specific to placenta‐mediated FGR. Among the charts evaluated, those of Rahimi et al ., Drukker et al . and Flately et al . demonstrated the best overall performance for predicting all three study outcomes. If confirmed in external cohorts, these findings would support the ongoing efforts to standardize the diagnosis of FGR, which is crucial for both clinical and research purposes. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

General anaesthesia for caesarean delivery carries specific maternal and neonatal risks. Drug choice, dose and timing during induction of general anaesthesia may influence maternal and neonatal physiology and outcomes. The objective of this umbrella review was to systematically identify, summarise and appraise evidence for pharmacological techniques for induction of general anaesthesia for caesarean delivery. Databases were searched for eligible studies, including meta-analyses, systematic reviews, randomised controlled trials not previously synthesised and relevant observational studies. Data extraction, methodological quality assessment and evaluation of evidence certainty were conducted. Interventions were grouped into four categories: induction opioids; induction hypnotics; drugs to obtund the pressor response to laryngoscopy; and neuromuscular blocking drugs. Seven meta-analyses, two systematic reviews, 26 randomised controlled trials and 15 observational studies were included. Moderate quality evidence indicated short-acting opioids offered maternal haemodynamic benefit without negative neonatal consequences. Low quality evidence indicated propofol was associated with equivalent early neonatal resuscitation requirements compared with thiopental, but with lower risk of maternal accidental awareness during general anaesthesia. Labetalol, dexmedetomidine, lidocaine and remifentanil attenuated maternal haemodynamic response to laryngoscopy, with minimal neonatal adverse effects. Rocuronium at dose of ≥ 1 mg.kg-1 provided comparable tracheal intubation conditions to suxamethonium without affecting neonatal outcomes, based on moderate quality evidence. Current evidence supports the safety of short-acting opioids, propofol as the preferred induction drug and rocuronium as a suitable alternative to suxamethonium during induction of anaesthesia for caesarean delivery. Overall, the evidence base is constrained by exclusion of high-risk pregnancies and emergency cases, thus limiting generalisability.

Prolonged neonatal cardiopulmonary resuscitation (CPR) is critical for survival in cases of severe bradycardia due to asphyxia. High-performance CPR, emphasizing consistent compression depth and full recoil, improves survival rates. This pilot study explored how environmental and provider-specific factors-including bed height, positioning, and anthropometry-affect the consistency of neonatal CPR using the 2-thumb technique. Twenty-two neonatal intensive care unit providers performed 2-minute CPR trials on a neonatal simulator under 2 conditions: self-selected bed height ("choice") and standardized bed height (100 cm, "pre-set"). Compression depth and recoil were recorded using simulator sensors. Postural changes and onset of sway were assessed via video analysis. Results from the head-of-bed position were compared with data from a prior side-of-bed study. Chest recoil decreased over time in both bed-height conditions, potentially compromising CPR effectiveness. Bed height did not impact the number of postural changes or time to sway with a head-of-bed approach. Compared to the side-of-bed position, head-of-bed placement resulted in fewer postural changes and delayed onset of sway. In the choice condition, taller providers and those with longer reach preferred higher bed heights. The head-of-bed approach may enhance motor performance by allowing pelvic stabilization against the bed, limiting lower-joint motion, and improving stability. However, this position may impair chest recoil over time, potentially reducing CPR effectiveness. Further research is needed to optimize ergonomic factors influencing neonatal resuscitation performance.

Spanish 2026 guidelines for neonatal stabilization and resuscitation: analysis, adaptation, and position statement of the neonatal resuscitation Group of the Spanish Society of Neonatology.

Adapting international pediatric and neonatal cardiopulmonary resuscitation guidelines for use in Spain: an inescapable need.

Disorders of sex development (DSDs) in newborns represent a challenging diagnosis for parents, often resulting in intense emotional distress, particularly in neonatal intensive care units (NICUs) where mortality risk is high. In Morocco, NICUs frequently manage such cases, yet data on parental experiences and support needs following DSD diagnosis remain limited. Previous studies on parental responses to congenital anomalies rarely focus specifically on DSDs in this context. This article aims to synthesize available evidence on the emotional impact and support requirements for parents of newborns diagnosed with DSDs. This was a descriptive study based on a questionnaire developed in the neonatal resuscitation unit, administered to parents of 18 newborns presenting with a sexual differentiation disorder. Responses were analyzed descriptively and qualitatively. Among the 18 parents included, 15 (83.3%) reported intense anxiety associated with decision-making stress. Difficulties in understanding medical information and emotional blockade were reported by 12 parents (66.7%). Fear regarding the child's health and future was reported by all parents (100%). Feelings of guilt and self-blame were reported by 5 parents (27.8%), attributed to genetic factors, medication exposure, or perceived moral fault. Rapid sex assignment was requested by 16 parents (88.9%), while denial was observed in 1 parent (5.6%). Psychological distress was more pronounced in parents whose infants required neonatal intensive care, particularly in the three cases that resulted in infant death. This synthesis highlights significant parental emotional vulnerability following the diagnosis of sex development disorders in newborns, further intensified by medical severity and the intensity of neonatal care. Health authorities, hospitals, multidisciplinary teams, and researchers should prioritize early empathetic interventions and tailored communication strategies to alleviate psychological distress and improve family outcomes in high-burden settings such as NICUs.

What's new in the 2026 pediatric cardiopulmonary resuscitation recommendations.

Approximately 10% of term newborns require resuscitation at birth. Training healthcare providers in standardised formal neonatal resuscitation training (SFNRT) programmes may improve neonatal outcomes. In the current update we focused on whether new literature confirmed our previous findings of a decrease in neonatal mortality and provided new reports of neonatal morbidity, particularly hypoxic ischaemic encephalopathy and neurodevelopmental outcomes. To determine whether SFNRT programmes reduce neonatal mortality and morbidity, improve teamwork behaviour, or improve acquisition and retention of knowledge and skills. We searched CENTRAL, MEDLINE, three other databases, and two trial registers, together with reference checking, citation and errata/retractions checking, to identify studies for inclusion in the review. The latest search date was June 2025. We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs in newborn infants that compared SFNRT with no SFNRT, with basic resuscitation training, or with SFNRT plus additional components such as booster (refresher) training. Our critical outcomes of interest were neonatal mortality (mortality in the first 28 days of life) and its components (mortality within 24 hours, within 7 days, and between 8 and 28 days of life) and neonatal morbidity. We assessed risk of bias in the included studies using the Cochrane RoB 1 tool. We used the fixed-effect model for meta-analysis and reported risk ratio (RR), risk difference (RD), mean difference (MD), and number needed to treat for an additional beneficial outcome (NNTB) and number needed to treat for an additional harmful outcome (NNTH) (all with 95% confidence intervals (CI)). We analysed cluster-RCTs using the generic inverse-variance and the approximate analysis methods. Where this was precluded by the nature of the data, we summarised the results narratively. We used GRADE to assess the certainty of evidence for each outcome. We included a total of 27 studies (528,366 newborns) in the review. However, only a maximum of four studies provided data for each outcome. SFNRT compared to no SFNRT SFNRT likely decreases 24-hour mortality (RR 0.73, 95% CI 0.66 to 0.82; I² = 0%; 2 studies, 353,527 participants; moderate-certainty evidence) and early neonatal mortality (RR 0.82, 95% CI 0.75 to 0.89; I² = 0%; 2 studies, 354,358 participants; moderate-certainty evidence). Neonatal mortality in the first 28 days, late neonatal mortality, and neonatal morbidities were not reported. SFNRT compared to basic resuscitation training SFNRT may decrease mortality in the first 28 days (RR 0.55, 95% CI 0.33 to 0.91; I² not applicable; 1 study, 3355 participants; low-certainty evidence). SFNRT likely decreases 24-hour mortality (RR 0.59, 95% CI 0.51 to 0.67; I² = 82%; 3 studies, 169,331 participants; moderate-certainty evidence) and early neonatal mortality (RR 0.88, 95% CI 0.77 to 0.99; I² = 68%; 4 studies, 69,264 participants; moderate-certainty evidence). SFNRT may not decrease late neonatal mortality (RR 0.47, 95% CI 0.20 to 1.11; I² not applicable; 1 study, 3274 participants; low-certainty evidence). Neonatal morbidities were not reported. SFNRT compared to SFNRT with boosters The evidence is very uncertain about the effect of SFNRT with boosters on mortality in the first 28 days (RR 1.23, 95% CI 0.46 to 3.27; I² not applicable; 1 study, 511 participants; very low-certainty evidence). Twenty-four-hour mortality, early neonatal mortality, late neonatal mortality, and neonatal morbidities were not reported. The overall risk of bias of the included studies was mixed due to high risk of performance bias in all RCTs. The available studies reporting mortality outcomes were conducted exclusively in low- and middle-income countries (LMICs). SFNRT, compared with no training, likely decreases mortality at 24 hours of life and in the first 7 days of life. SFNRT, compared with basic resuscitation training, may decrease mortality in the first 28 days of life, likely decreases mortality at 24 hours and 7 days of life, but may not decrease late neonatal mortality. The evidence is very uncertain whether SFNRT with boosters affects mortality in the first 28 days of life. This update confirms our 2015 review findings of decreased neonatal mortality, but did not identify any reports on neonatal morbidity, particularly hypoxic ischaemic encephalopathy and neurodevelopmental outcomes. This Cochrane review had no dedicated funding. Protocol (2011) DOI: 10.1002/14651858.CD009106. Original review (2015) DOI: 10.1002/14651858.CD009106.pub2.

ObjectiveDespite advancements in technologies, the quality of intrapartum care has consistently not improved. This study evaluates the potential efficacy of a novel technology for newborn resuscitation, which provides a visual display of time since birth, video–audio recording, and ergonomic resuscitation equipment, on healthcare providers’ performance during ventilation in Nepal.MethodThis study utilized a prospective observational design conducted over 3 years at a referral hospital in Nepal. All infants who did not cry within 30 seconds of birth were included, and their ventilation performance was assessed across two phases: SUSTAIN (baseline phase) and Pre-MALA (pilot implementation phase). Ventilation performance was measured through direct observation and video annotation, with the median time to first ventilation compared between the two phases using the Mann–Whitney U test and generalized linear mixed model regression.ResultsA total of 164 newborn ventilation events were observed, with 78 during the SUSTAIN phase and 86 during Pre-MALA phase. Direct observation was done in both phases, while video-recording annotation was also conducted during Pre-MALA phase. The median time to first ventilation significantly decreased from 84.3 seconds (interquartile range (IQR): 55.4–114.0) during SUSTAIN to 48.2 seconds (IQR: 33.5–85.0) during Pre-MALA (p < 0.001). The duration of suctioning before ventilation was reduced by 17.8 seconds (adjusted coefficient = −17.8; 95% CI; −23.1, −11.8) and time to first ventilation was reduced by 33 seconds (adjusted coefficient = −33.2; 95% CI; −51.1, −15.4) during Pre-MALA.ConclusionThe result suggests that novel technology during resuscitation can reduce time to first ventilation and unnecessary suctioning in a clinical setting. Further large-scale evaluations are needed to fully assess the potential impact on neonatal care.

Designing, developing and applying an instructional framework for a neonatal resuscitation program: Action research.

As pediatric and neonatal hospitalists assume increasing care for newborns in the delivery room and during the birth hospitalization, preparing pediatric trainees with foundational skills in neonatal resuscitation is increasingly critical. However, residency programs may face challenges in providing sufficient delivery room exposure and procedural opportunities given newer training requirements and updated care practices that reduce procedural interventions during neonatal resuscitation. In this Perspectives article, we examine factors contributing to these gaps, describe our institution's hospitalist-led strategies to optimize resident delivery room training, and highlight complementary educational approaches and future directions to optimally prepare trainees entering the hospital workforce.

From constraints to solutions: leveraging low-cost, scalable simulation for safer neonatal resuscitation.

Comment on “The impact of high-fidelity neonatal resuscitation simulation training on nursing students’ communication, satisfaction and confidence, self-efficacy, and clinical competency”

Over the past five years, the system of training pediatric anesthesiology specialists in Ukraine has undergone substantial reorganization. The organization of such training can be divided into two distinct periods — before 2021 and after 2021. These differences are primarily related to the conditions and structure of postgraduate training, which occurs mainly during internship and subsequent specialization. Prior to 2021, the specialty “Pediatric Anesthesiology” was included in the list of internship training programs for medical university graduates. The primary specialization (internship) in pediatric anesthesiology lasted 2 years and had certain advantages: enrollment was limited to graduates of the Faculty of Pediatrics, and the main methodological principle was the development of independent professional activity under controlled supervision. Since 2021, the number of internship specialties has been reduced to 23, and “Pediatric Anesthesiology” has been excluded from this list. Training in pediatric anesthesiology is now possible only after completion of an internship in general anesthesiology, followed by specialization in pediatric anesthesiology. The training program for anesthesiologists includes 13 sections, the core of which are devoted to the anatomical and physiological characteristics of the child’s body, principles of preoperative preparation of children for anesthesia and surgery, age- and procedure-specific features of anesthesia in children, performance of cardiopulmonary resuscitation in newborns and children, and the fundamentals of pediatric intensive care. Conclusions. The differences in the training systems for pediatric anesthesiology have not demonstrated a clear superiority of one approach over the other in producing competent specialists. However, the current model — training in pediatric anesthesiology and intensive care following an internship in general anesthesiology, followed by targeted specialization — offers certain advantages.