Neonatal Resuscitation Skills Research Articles

A Randomized Controlled Simulation Trial of a Neonatal Resuscitation Digital Game Simulator for Labour and Delivery Room Staff.

Healthcare providers (HCPs) working in labour and delivery rooms need to undergo regular refresher courses to maintain their neonatal resuscitation skills, which are shown to decline over time. However, due to their irregular schedules and limited time, HCPs encounter difficulties in readily accessing refresher programs. RETAIN is a digital game that simulates a delivery room to facilitate neonatal resuscitation training for HCPs. This study aims to ascertain whether participants enjoyed the RETAIN digital game simulator and whether it was at least as good as a video lecture at refreshing and maintaining participants' neonatal resuscitation knowledge. In this randomized controlled simulation trial, n = 42 labour and delivery room HCPs were administered a pre-test of neonatal resuscitation knowledge using a manikin. Then, they were randomly assigned to a control or a treatment group. For 20-30 min, participants in the control group watched a neonatal resuscitation lecture video, while those in the treatment group played the RETAIN digital game simulator of neonatal resuscitation scenarios. Then, all participants were administered a post-test identical to the pre-test. Additionally, participants in the treatment group completed a survey of attitudes toward the RETAIN simulator that provided a measure of enjoyment of the RETAIN game simulator. After two months, participants were administered another post-test identical to the pre-test. For the primary outcome (neonatal resuscitation performance), an analysis of variance revealed that participants significantly improved their neonatal resuscitation performance over the first two time points, with a significant decline to the third time point, the same pattern of results across conditions, and no differences between conditions. For the secondary outcome (attitudes toward RETAIN), participants in the treatment condition also reported favourable attitudes toward RETAIN. Labour and delivery room healthcare providers in both groups (RETAIN simulator or video lecture) significantly improved their neonatal resuscitation performance immediately following the intervention, with no group differences. The findings suggest that participants enjoyed interacting with the RETAIN digital game simulator, which provided a similar boost in performance right after use to the more traditional intervention.

Effectiveness of simulation-based interprofessional education on teamwork and communication skills in neonatal resuscitation

BackgroundThe role of effective interprofessional teamwork is especially vital in the Neonatal Intensive Care Unit (NICU) where infants facing emergency situations are admitted. Proper neonatal resuscitation, facilitated by comprehensive resuscitation training, can significantly decrease the mortality rates associated with neonatal asphyxia and respiratory failure. This study aimed to develop a simulation-based interprofessional education (IPE) programme for medical staff working in a nursery and NICU and to assess its effectiveness on teamwork, communication skills, clinical performance, clinical judgement, interprofessional attitudes, and education satisfaction.MethodsThrough a demand survey, neonatal resuscitation was selected as the theme, and an IPE team comprised of one doctor and two nurses was formed. The education programme consisted of three sessions lasting a total of 140 min: two simulation exercises and one theoretical education session. Data were collected from 18 nurses working in the nursery and NICU and 9 doctors working in the paediatrics department.ResultsA comparison of the metrics before and after applying simulation-based IPE programmes revealed teamwork (Z=-2.67, p = .008), communication skills (Z=-2.68, p = .007), clinical performance (Z=-2.52, p = .012), clinical judgement (Z=-4.52, p < .001), and interprofessional attitude (Z=-3.64, p < .001) to have significantly improved. Education satisfaction scores were 4.73 points on average out of a maximum of 5. The simulation-based IPE programme was effective in improving the teamwork, communication, and clinical performance of resuscitation teams, individual clinical judgement, and interprofessional attitude.ConclusionsSimulation-based IPE is effective for enhancing teamwork, team communication, clinical judgement skills, and clinical performance in neonatal resuscitation. This programme has the potential to contribute to the improvement of patient safety and the quality of neonatal care. Additional studies are needed to longitudinally examine the effects of the programme on patient safety and quality of neonatal care.

Use of digital technologies for staff education and training programmes on newborn resuscitation and complication management: a scoping review

BackgroundPoor-quality care is linked to higher rates of neonatal mortality in low-income and middle-income countries (LMICs). Limited educational and upskilling opportunities for healthcare professionals, particularly those who work in remote...

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.

Method of Anesthesia and Perioperative Risk Factors, Maternal Anesthesia Complications, and Neonatal Mortality Following Cesarean Delivery in Africa: A Substudy of a 7-Day Prospective Observational Cohort Study.

The African Surgical Outcomes Study (ASOS) found that maternal mortality following cesarean delivery in Africa is 50 times higher than in high-income countries, and associated with obstetric hemorrhage and anesthesia complications. Mothers who died were more likely to receive general anesthesia (GA). The associations between GA versus spinal anesthesia (SA) and preoperative risk factors, maternal anesthesia complications, and neonatal outcomes following cesarean delivery in Africa are unknown. This is a secondary explanatory analysis of 3792 patients undergoing cesarean delivery in ASOS, a prospective observational cohort study, across 22 African countries. The primary aim was to estimate the association between preoperative risk factors and the outcome of the method of anesthesia delivered. Secondary aims were to estimate the association between the method of anesthesia and the outcomes (1) maternal intraoperative hypotension, (2) severe maternal anesthesia complications, and (3) neonatal mortality. Generalized linear mixed models adjusting for obstetric gravidity and gestation, American Society of Anesthesiologists (ASA) category, urgency of surgery, maternal comorbidities, fetal distress, and level of anesthesia provider were used. Of 3709 patients, SA was performed in 2968 (80%) and GA in 741 (20%). Preoperative factors independently associated with GA for cesarean delivery were gestational age (adjusted odds ratio [aOR], 1.093; 95% confidence interval [CI], 1.052-1.135), ASA categories III (aOR, 11.84; 95% CI, 2.93-46.31) and IV (aOR, 11.48; 95% CI, 2.93-44.93), eclampsia (aOR, 3.92; 95% CI, 2.18-7.06), placental abruption (aOR, 6.23; 95% CI, 3.36-11.54), and ruptured uterus (aOR, 3.61; 95% CI, 1.36-9.63). SA was administered to 48 of 94 (51.1%) patients with eclampsia, 12 of 28 (42.9%) with cardiac disease, 14 of 19 (73.7%) with preoperative sepsis, 48 of 76 (63.2%) with antepartum hemorrhage, 30 of 55 (54.5%) with placenta previa, 33 of 78 (42.3%) with placental abruption, and 12 of 29 (41.4%) with a ruptured uterus. The composite maternal outcome "all anesthesia complications" was more frequent in GA than SA (9/741 [1.2%] vs 3/2968 [0.1%], P < .001). The unadjusted neonatal mortality was higher with GA than SA (65/662 [9.8%] vs 73/2669 [2.7%], P < .001). The adjusted analyses demonstrated no association between method of anesthesia and (1) intraoperative maternal hypotension and (2) neonatal mortality. Analysis of patients undergoing anesthesia for cesarean delivery in Africa indicated patients more likely to receive GA. Anesthesia complications and neonatal mortality were more frequent following GA. SA was often administered to high-risk patients, including those with eclampsia or obstetric hemorrhage. Training in the principles of selection of method of anesthesia, and the skills of safe GA and neonatal resuscitation, is recommended.

Virtual simulations for neonatal education

Virtual simulation (VS) education involves the use of virtual reality, augmented reality, mixed reality and screen-based platforms, collectively referred to as extended reality, to provide education and assessment. This novel simulation modality supports experiential learning and increases access to practice opportunities, supplementing manikin-based simulation. VS has been used successfully for neonatal resuscitation training in high and low resource settings. Virtual simulators can be used to objectively assess learner performance in neonatal resuscitation knowledge and skills. When implementing VS for neonatal resuscitation training, key considerations include matching learning objectives with suitable technology, pre-session preparation, supporting learners, and debriefing. Additional research is needed to evaluate the impact of VS applications on clinical practice and patient outcomes.

A Pilot Study on Testing Real Life Delivery Room Experience by Direct Observation and Supervised “Hands-on” Component in Imparting Neonatal Resuscitation Skill to Intern Doctor

Background Intern doctors are often incompetent to perform neonatal resuscitation, which is an essential skill and core competency area of pediatric curriculum. Methods We aimed to analyze the impact of direct observation and supervised “hands-on” component along with standard basic neonatal resuscitation training for intern doctors. An educational interventional study was conducted among interns after being approved by ethics committee. Mannequin based Basic neonatal resuscitation training of intern doctors was demonstrated. After that one week observership for real-life experience in NICU was given, where they observed minimum 5 delivery calls under the supervision of senior resident/faculty. Learning gain of the interns was analyzed by comparing the pre- and post-training test score. Knowledge based questions and objective structured clinical examination (OSCE) stations were used for the assessment. The OSCE was used to check the skills acquisition among intern doctors. Interns post workshop and post observership feedback in the form of reflection were analyzed. Faculty’s feedback in the form of reflection was analyzed. Results A total of 8 interns completed both pre and post training test for the level 2 evaluation-learning gain. Mean test scores of knowledge based questions and OSCE increased significantly from 85% to 97.5% and 33.33% to 100%, respectively. Pre- and post-workshop OSCE revealed 100% achievement of clinical skill of neonatal resuscitation. Intern doctors perceive that NRP training program improved their confidence levels and decreased the fear to perform neonatal resuscitation during first golden hour of life to save life of newborn. BNRP program is one of the core components to impart a clinical skill as an integral part of learning during internships. Conclusion Direct observation and supervised “hands-on” component as an additional teaching-learning method was well perceived and competency of interns for neonatal resuscitation was significantly enhanced. BNRCP competent IMG/intern being the first contact physician will be able to survive the newborn and contribute in decreasing neonatal mortality rate.

Scale Up of Neonatal Resuscitation Training and Skill Retention in Five Provinces of Nepal.

To reduce neonatal mortality attributable to intrapartum hypoxic events, Latter-days Saint Charities (LDSC) and Safa Sunaulo Nepal (SSN) implemented a neonatal resuscitation training, scale-up, and skill retention program. This article reports on the LDSC/SSN dissemination program and newborn outcomes associated with its implementation. To evaluate the program, we used a prospective cohort design to compare outcomes of birth cohorts in 87 health facilities preimplementation and postimplementation of the facility-based training. A paired T-test was used to determine whether baseline and endline values were significantly different. Resuscitation training began with trainers from 191 facilities attending Helping Babies Breathe (HBB) training-of-trainer (ToT) courses. Thereafter, 87 facilities from five provinces received active mentoring, scale-up assistance (6389 providers trained), and skill retention support. The LDSC/SSN program was associated with decreases in the number of intrapartum stillbirths in all provinces except Bagmati. Neonatal deaths within 24 hours of birth decreased significantly in Lumbini, Madhesh, and Karnali provinces. Morbidity associations, as defined by sick newborn transfers, decreased significantly in Lumbini, Gandaki, and Madhesh provinces. The LDSC/SSN model of neonatal resuscitation training, scale-up, and skill retention has the potential to significantly improve perinatal outcomes. It could potentially guide future programs in Nepal and other resource-limited settings.

Effect of repeat refresher courses on neonatal resuscitation skill decay: an experimental comparative study of in-person and video-based simulation training

Neonatal deaths are a major contributor to global under-5-year-old mortality. Training birth attendants can improve perinatal outcomes, but skills may fade over time. In this pilot study, we assessed skill decay of nursing students after remote video versus in-person resuscitation training in a low-resource setting. Filipino nursing students (n = 49) underwent traditional, in-person simulation-based Helping Babies Breathe (HBB) training in Mindanao, Philippines. Participants were then assigned to receive refresher training at 2-month intervals either in-person or via tele-simulation beginning at 2 months, 4 months, or 6 months after initial training. A knowledge examination and practical examination, also known as objective structured clinical examination B in the HBB curriculum, were administered before retraining to assess knowledge and skill retention at time of scheduled follow-up. Time to initiation of bag-mask ventilation (BMV) in seconds during simulated birth asphyxia was the primary outcome. Skill decay was evident at first follow-up, with average time to BMV increasing from 56.9 (range 15–87) s at initial post-training to 83.8 (range 32–128) s at 2 months and 90.2 (range 51–180) s at 4 months. At second follow-up of the 2-month group, students showed improved pre-training time to BMV (average 70.4; range 46–97 s). No statistical difference was observed between in-person and video-trained students in time to BMV. Because of COVID-19 restrictions, the 6-month follow-up was not completed. We conclude that remote video refresher training is a reasonable alternative to traditional in-person HBB training. Our study also suggests that refreshers may be needed more frequently than every 2 months to mitigate skill decay. Additional studies are necessary to assess the longitudinal impact of tele-simulation on clinical outcomes.

Scale-Up of a Newborn Resuscitation Capacity-Building and Skill Retention Program Associated With Improved Neonatal Outcomes in Gandaki Province, Nepal.

Intrapartum events leading to asphyxia at birth are a leading cause of neonatal morbidity and mortality in Nepal. In response, the Nepal Ministry of Health and Population adopted the Helping Babies Breathe (HBB) training curriculum in 2015 as a tool to improve neonatal resuscitation and outcomes. Although the effectiveness of HBB training has been well documented, challenges remain in maintaining skills over time. Safa Sunaulo Nepal (SSN) designed an evidence-based intervention for scaling up newborn resuscitation training and skill retention. We report on its implementation and the changes in newborn outcomes during the program period. The program empowered facility-based trainers in newborn resuscitation and skill retention at 12 facilities in Gandaki Province. Seven of 14 level I hospitals and 5 of 6 level II hospitals were selected. A single external mentor coached the facility-based trainers, provided general support, and monitored progress. Program evaluation tracked changes in newborn metrics over 21 Nepali months (March 2018-November 2019). All deliveries occurring in the health facilities during the program period were included in the evaluation. We assessed program effectiveness by analyzing time trends of neonatal mortality, morbidity, and stillbirths. We gathered data on neonatal health outcomes of 33,417 deliveries, including 23,820 vaginal deliveries and 9,597 cesarean deliveries. During the program, 43 facility-based trainers taught resuscitation skills to 425 medical personnel and supported skill retention. Neonatal deaths within 24 hours of birth (incidence rate ratio [IRR]=0.993, P=.044) and newborn morbidities (IRR=0.996, P<.001) showed a significantly declining trend. Our findings suggest that the SSN program had a substantial influence on critical neonatal outcomes. Future neonatal resuscitation capacity-building and skill retention efforts may benefit from incorporating elements of the program.

Improving the ability of nursing students in neonatal resuscitation by using the Helping Babies Breathe Program: A quasi-experimental study

BackgroundNursing graduates must have sufficient skills to perform adequately in newborn resuscitations. New nurses should be provided with appropriate situations in order to practice the necessary skills required during a newborn resuscitation. This study aimed to improve the performance of nursing students during neonatal resuscitations through the use of a Helping Babies Breathe Program. MethodsThis quasi-experimental study with a control group (simulator with low similarity) and an interventional group (Helping Babies Breathe Program) was conducted on 84 eighth-semester nursing students studying at Isfahan University of Medical Sciences, Iran. A resuscitation workshop was held for a single day for 5 h with students performing standard practices for each step of the resuscitation. Knowledge and skills of students were assessed using two scenarios and a standardized checklist. ResultsThe mean score of knowledge and basic neonatal resuscitation skills were significantly different between the two groups before and immediately after training, as well as Post-Internship (p < 0.05). The highest score of knowledge (17.38) belonged to the intervention group. Appropriate skills are critically important when performing bag-valve-mask ventilation. Before the intervention occurred, students in the interventional group obtained the lowest scores in resuscitation skills; however, after the intervention, all interventional group students obtained a full score and demonstrated the necessary skills required for effective newborn resuscitations. ConclusionResuscitation training through the use of a high-similarity simulator was significantly more effective than utilizing a low-similarity simulator when performing basic neonatal resuscitation.

Mini NRP Sessions Improve Nurse Confidence and Competence

Neonatal resuscitation program (NRP) classes, skills review, and mega codes are completed every 2 years. Nurses report feeling unprepared for emergency situations and lack confidence and competence in their neonatal resuscitation skills.

Updates for the Neonatal Resuscitation Program and Resuscitation Guidelines.

Although most newborns require no assistance to successfully transition to extrauterine life, the large number of births each year and limited ability to predict which newborns will need assistance means that skilled clinicians must be prepared to respond quickly and efficiently for every birth. A successful outcome is dependent on a rapid response from skilled staff who have mastered the cognitive, technical, and behavioral skills of neonatal resuscitation. Since its release in 1987, over 4.5 million clinicians have been trained by the American Heart Association and American Academy of Pediatrics Neonatal Resuscitation Program®. The guidelines used to develop this program were updated in 2020 and the Textbook of Neonatal Resuscitation, 8th edition, was released in June 2021. The updated guidelines have not changed the basic approach to neonatal resuscitation, which emphasizes the importance of anticipation, preparation, teamwork, and effective ventilation. Several practices have changed, including the prebirth questions, initial steps, use of electronic cardiac monitors, the initial dose of epinephrine, the flush volume after intravascular epinephrine, and the duration of resuscitation with an absent heart rate. In addition, the program has enhanced components of the textbook to improve learning, added new course delivery options, and offers 2 course levels to allow learners to study the material that is most relevant to their role during neonatal resuscitation. This review summarizes the recent changes to the resuscitation guidelines, the textbook, and the Neonatal Resuscitation Program course.

A distributed learning strategy improves performance and retention of skills in neonatal resuscitation

Skill retention after neonatal resuscitation training is poor. A distributed learning strategy – where learning is spread over multiple sessions – can improve retention of declarative memory (facts &amp; knowledge). Session timings are critical – maximal retention occurs when a refresher session is scheduled at 10-30% of the time between initial training and test. We hypothesized this also holds true for neonatal resuscitation, a complex skill set requiring both declarative and procedural memory. We conducted a prospective, single-blinded randomized-controlled trial. University of Ottawa residents were recruited to training in neonatal resuscitation, with a high-fidelity simulated pre-test, immediate post-tests, and a retention test at 4 months. After training, they were randomized to either a refresher session at 3 weeks (18% of interval) or at 2 months (50%). Technical and non-technical skills were scored using validated checklists, knowledge with standardized questions. There was no difference between groups prior to the retention test. The early refresher group demonstrated significantly improved technical (mean ± 95% CI: 22.4 ± 1.3 v 18.2 ± 2.5, p = 0.02) and non-technical (31.0 ± 0.9 v 25.6 ± 3.1, p = 0.03) skill scores in the retention post-test compared to the late group. No difference was seen with knowledge scores. We conclude that both technical and non-technical aspects of neonatal resuscitation performance can benefit from an early refresher session. Session timings are critical and should be tailored to the desired length of skill retention. Findings may be generalizable to other interventions that depend on mixed types of memory.

Neonatal Resuscitation Skill-Training Using a New Neonatal Simulator, Facilitated by Local Motivators: Two-Year Prospective Observational Study of 9000 Trainings.

Globally, intrapartum-related complications account for approximately 2 million perinatal deaths annually. Adequate skills in neonatal resuscitation are required to reduce perinatal mortality. NeoNatalie Live is a newborn simulator providing immediate feedback, originally designed to accomplish Helping Babies Breathe training in low-resource settings. The objectives of this study were to describe changes in staff participation, skill-training frequency, and simulated ventilation quality before and after the introduction of “local motivators” in a rural Tanzanian hospital with 4000–5000 deliveries annually. Midwives (n = 15–27) were encouraged to perform in situ low-dose high-frequency simulation skill-training using NeoNatalie Live from September 2016 through to August 2018. Frequency and quality of trainings were automatically recorded in the simulator. The number of skill-trainings increased from 688 (12 months) to 8451 (11 months) after the introduction of local motivators in October 2017. Staff participation increased from 43% to 74% of the midwives. The quality of training performance, measured as “well done” feedback, increased from 75% to 91%. We conclude that training frequency, participation, and performance increased after introduction of dedicated motivators. In addition, the immediate constructive feedback features of the simulator may have influenced motivation and training quality performance.

Identifying factors associated with neonatal resuscitation skills among nurses and midwives in Tanzania, sub-Saharan Africa.

Objective:The objective of this study was to identify factors associated with nurses’ and midwives’ skills in performing neonatal resuscitation.Method:Health facility-based analytical cross-sectional study design was employed from January 2021 to April 2021 among 340 nurses and midwives selected by multistage random sampling technique. An observation checklist was used to collect data. Data were coded and entered into SPSS version 20 for analysis. Bivariate and multivariate logistic regression was used to assess factors associated with nurse/midwives’ skills in neonatal resuscitation.Results:Among 340 nurses and midwives, 141 (41%) had adequate skills in neonatal resuscitation. After adjusting for confounders, factors associated with adequate skills were; age of the midwives (20–34 (adjusted odds ratio = 0.082, p < 0.008) and 35–49 (adjusted odds ratio = 0.087, p < 0.010)); work experience (worked 4–6 (adjusted odds ratio = 2.905, p < 0.003) and > 10 years and above (adjusted odds ratio = 12.825, p < 0.000)); district hospitals (adjusted odds ratio = 1.544, p = 0.032); distance from place of residence (6–10 km (adjusted odds ratio = 0.090, p < 0.001) and > 16 km (adjusted odds ratio = 0.049, p < 0.001)); number of midwives per shift, ⩾ 4 (adjusted odds ratio = 2.396, p = 0.012) and number of deliveries per day (6–10 (adjusted odds ratio = 1.385, p < 0.031), 11–20 (adjusted odds ratio = 2.693, p < 0.016) and > 20 delivery per day (adjusted odds ratio = 6.007, p < 0.001).Conclusion:Less than half of the observed nurses and midwives had adequate skills in neonatal resuscitation. Nurses and midwives who were younger, less experienced (<4 years of work experience), and work in small, lower volume settings with fewer colleagues and limited births (dispensaries, fewer than four nurses and midwives per shift, less than six deliveries per day) were less likely to have adequate skills in neonatal resuscitation. Knowledge gained from this study may provide future research related to a cost-effective strategy to empower nurses and midwives in neonatal resuscitation.

Assessment of neonatal resuscitation skills among healthcare workers in Uasin Gishu County, Kenya

Objective:Neonatal resuscitation is key in preventing neonatal mortality. The objective of this study was to assess the competence of healthcare workers in basic neonatal resuscitation at six hospitals in Uasin Gishu County in Kenya.Methods:This was a cross-sectional study of healthcare workers based on the labor and delivery wards.Results:Of the 46 healthcare workers who were assessed with a written examination and skills assessment, 85% were nurses. While 46% were able to pass the written examination, none demonstrated all required steps of newborn resuscitation during the skills assessment by simulation. No significant associations were present between the pass rate of the written examination and years of experience, role, or prior in-service training. All of the hospitals had the basic equipment required for neonatal resuscitation.Conclusion:There is a need to further develop the neonatal resuscitation skills among healthcare workers in the labor and delivery wards in Uasin Gishu County, Kenya.

Determinants of Skilled Birth Attendants in Neonatal Resuscitation at Nakuru Level Five Hospital, Kenya.

This study sought to determine the skills of the birth attendants in neonatal resuscitation at Nakuru Level five Hospital. Prospective study was used to determine the immediate outcomes of neonatal resuscitation where sixty resuscitated new-borns were recruited into the study and followed up for a period of one month. A descriptive cross-sectional study was used to assess the knowledge and skills of skilled birth attendants where thirty six skilled birth attendants were included in the study with various educational level Certificate, Diploma and Bachelors. Self-administered questionnaires were used to assess knowledge while simulated resuscitation using mannequins was used to assess the skills. Multiple linear regressions were used to compare the mean differences. The findings showed that there were a higher number of resuscitated new-borns among prim gravidas, mothers aged below 20 years and referrals cases. Furthermore male new-borns were found to be twice more likely to be resuscitated than female new-borns. There is need to put emphasis teaching of neonatal resuscitation in all pre-service medical institutions to help reduce the noted discrepancies skills. Efforts should be made by the stake holders; both national and county governments to provide refresher courses yearly to all the staff since it has been demonstrated as having impact on the skills of neonatal resuscitation.

Effect of a Low-Dose/High-Frequency Training in Introducing a Nurse-Led Neonatal Advanced Life Support Service in a Referral Hospital in Ethiopia

Background and Objective: In Ethiopia, birth asphyxia causes ~30% of all neonatal deaths and 11–31% of deaths among neonates delivered in healthcare facilities that have breathing difficulty at birth. This study aimed to examine the impact of low-dose, high-frequency (LDHF) training for introducing a nurse-led neonatal advanced life support (NALS) service in a tertiary care hospital in Ethiopia.Methods: Through a retrospective cohort study, a total of 12,001 neonates born post-implementation of the NALS service (between June 2017 and March 2019) were compared to 2,066 neonates born before its implementation (between June 2016 and September 2016). Based on when the neonates were born, they were divided into six groups (groups A to F). All deliveries occurred in the inpatient Labor and Delivery Unit (LDU) at St. Paul's Hospital Millennium Medical College. The number of neonatal deaths in the LDU, neonatal intensive care unit (NICU) admission rate, and proportion of neonates with normal axillary temperature (36.5–37.5°C) within the first hour of life were evaluated. Data were analyzed using the χ2 test, and p-values < 0.05 were considered statistically significant. Following the implementation of the NALS service, semi-structured interviews with key stakeholders were conducted to evaluate their perception of the service; the interviews were recorded, transcribed, and coded for thematic analysis.Results: There was a decrease in the proportion of neonates who died in the LDU (from 3.5 to 1%) during the immediate post-implementation period, followed by a sustained decrease over the study period (p < 0.001). The change in the NICU admission rate (from 22.8 to 21.2%) was insignificant (p = 0.6) during this initial period. However, this was followed by a significant sustained decrease (7.8% in group E and 9.8% in group F, p < 0.001). The proportion of newborns with normal axillary temperature improved from 46.2% during the initial post-implementation period to 87.8% (p < 0.01); this proportion further increased to 99.8%. The program was perceived positively by NALS team members, NICU care providers, and hospital administrators.Conclusion: In resource-limited settings, LDHF training for neonatal resuscitation improves the neonatal resuscitation skills and management of delivery room attendants.

Evaluating Knowledge and Skills Retention of Helping Babies Breathe Training among Trainees over the Period of Time in Kavre, Nepal

Introduction: Helping Babies Breathe and Helping Babies Survive (HBS) programs are designed to develop basic neonatal resuscitation skills and knowledge aimed at the first minutes after birth. The programs were implemented at Scheer Memorial Adventist Hospital in Banepa, Kavre, Nepal. This study aimed to evaluate the success of training participants and maintaining their skills over time. Methods: The programs were implemented at SMAH over three years for staff and students involved in maternal / foetal medicine. Skills and knowledge of 119 participants were evaluated prior to training, after training, and again at five separate time intervals using standardised tests. Results: The training resulted in increased scores on knowledge testing from pre-test to post-test. Knowledge retention over time was shown to have a statistically significant decrease from post-test to retest. An objective structured clinical examination A performance did not show statistically significant decrease over time from post-test to retest. For the objective structured clinical examination B, there was a statistically significant decrease in scores over time from post-test to retest. Conclusions: The training resulted in a significant improvement in passing scores on knowledge and skills testing. While a statistically significant decrease in scores on testing was seen, the clinical significance of these decreases is questionable. This study shows that with implementation and continued practice, both knowledge and skills for basic neonatal resuscitation can be achieved and maintained.