Neonatal Resuscitation

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Georg M. Schmölzer - One of the best experts on this subject based on the ideXlab platform.

  • digital simulation improves maintains and helps transfer health care providers Neonatal Resuscitation knowledge
    Frontiers in Pediatrics, 2021
    Co-Authors: Simran K Ghoman, Georg M. Schmölzer, Maria Cutumisu
    Abstract:

    Purpose: To safely care for their newborn patients, health-care professionals (HCP) must undergo frequent training to improve and maintain Neonatal Resuscitation knowledge and skills. However, the current approach to Neonatal Resuscitation simulation training is time and resource-intensive, and often inaccessible. Digital Neonatal Resuscitation simulation may present a convenient alternative for more frequent training. Method: Fifty Neonatal HCPs participated in the study (44 female; 27 nurses, 3 nurse practitioners, 14 respiratory therapists, 6 doctors). This study was conducted at a tertiary perinatal center in Edmonton, Canada from April–August 2019, with 2-month (June–October 2019) and 5-month (September 2019–January 2020) follow-up. Neonatal HCPs were recruited by volunteer sampling to complete a demographic survey, pre-test (baseline knowledge), two digital simulation scenarios (intervention), and post-test (knowledge acquisition). Two months later, participants repeated the post-test (knowledge retention). Five months after the initial intervention, participants completed a post-test using a table-top simulation (knowledge transfer). Longitudinal analyses were used to compare participants' performance over time. Results: Overall the proportion of correct performance increased: 21/50 (42%) passed the pre-test, 39/50 (78%) the post-test, 30/43 (70%) the 2-month post-test, and 32/40 (80%) the 5-month post-test. GLMM and GEE analyses revealed that performance on all post-tests was significantly better than the performance on the pre-test. Therefore, training with the RETAIN digital simulation effectively improves, maintains, and transfers HCPs' Neonatal Resuscitation knowledge. Conclusions: Digital simulation improved, maintained, and helped transfer HCPs' Neonatal Resuscitation knowledge over time. Digital simulation presents a promising approach for frequent Neonatal Resuscitation training, particularly for distance-learning applications.

  • unsupervised machine learning algorithms examine healthcare providers perceptions and longitudinal performance in a digital Neonatal Resuscitation simulator
    Frontiers in Pediatrics, 2020
    Co-Authors: Georg M. Schmölzer, Maria Cutumisu, Simran K Ghoman
    Abstract:

    Background Frequent simulation-based education is recommended to improve health outcomes during Neonatal Resuscitation, but is often inaccessible due to time, resource, and personnel requirements. Digital simulation presents a potential alternative, however its effectiveness and reception by healthcare professionals (HCP) remains largely unexplored. Objectives This study explores HCPs’ attitudes towards a digital simulator, technology, and mindset to elucidate their effects on Neonatal Resuscitation performance in simulation-based assessments. Methods The study was conducted from April-August 2019, with 2-month (June-October 2019) and 5-month (September 2019-January 2020) follow-up at a tertiary perinatal centre in Edmonton, Canada. Of 300 available Neonatal HCPs, 50 participated. Participants completed a demographic survey, pre-test, two practice scenarios using the RETAIN Neonatal Resuscitation digital simulation, post-test, and attitudinal survey (100% response rate). Participants repeated the post-test scenario in two-months (86% response rate) and completed another post-test scenario using a low-fidelity table-top simulator (80% response rate) five-months after the initial study intervention. Participants’ survey responses were collected to measure attitudes towards digital simulation, technology, and mindset. Knowledge was assessed at baseline (pre-test), acquisition (post-test), retention (2-month post-test), and transfer (5-month post-test). Results Fifty Neonatal HCPs participated in this study (44 females and 6 males; 27 nurses, 3 nurse practitioners, 14 respiratory therapists, and 6 doctors). Most participants reported technology in medical education as useful and beneficial. Three attitudinal clusters were identified by a hierarchical clustering algorithm based on survey responses. Although participants exhibited diverse attitudinal paths, they all improved Neonatal Resuscitation performance after using the digital simulator and successfully transferred their knowledge to a new medium. Conclusions Digital simulation improved HCPs’ Neonatal Resuscitation performance. Medical education may benefit by incorporating technology during simulation training.

  • novel technologies for heart rate assessment during Neonatal Resuscitation at birth a systematic review
    Resuscitation, 2019
    Co-Authors: Peter A Johnson, Poyin Cheung, Megan Oreilly, Georg M. Schmölzer
    Abstract:

    Abstract Background 6.5–9 million newborns worldwide require Resuscitation at birth annually. During Neonatal Resuscitation, inaccurate or slow heart rate (HR) assessments may significantly increase risk of infant mortality or morbidity. Therefore fast, accurate, and effective HR assessment tools are critical for Neonatal Resuscitation. Objective To systematically review the literature about accuracy, latency, and efficacy of technologies for HR assessment during Neonatal Resuscitation. Methods Adhering to PRISMA guidelines, PubMed, EMBASE, and Google Scholar databases were systematically searched to identify studies related to technologies for HR assessment, which could be used to guide Neonatal Resuscitation. Results Forty-six studies evaluating HR assessment technologies for Neonatal Resuscitation were identified. In total, 16 studies (3/16 randomized trials and 13/16 observational studies) compared two or more HR assessment technologies to measure accuracy, latency, and efficacy. Of the trials, 1/3 had a low risk of bias while 2/3 had high risks. All observational studies had high risks of bias. Most studies considered infants not requiring Resuscitation, constituting indirect evidence and lower certainty in the context of Neonatal Resuscitation. Two trials reported faster times to HR assessment using electrocardiogram with a mean(SD) 66(20) versus 114(39) s and a median(IQR) 24(19–39) versus 48(36–69) s (both p  Conclusion While electrocardiography is faster to assess HR at birth and more reliable to detect HR changes compared to other recommended technologies, practice should not exclusively rely on ECG. While novel technologies could support HR assessment, no studies validate their clinical efficacy during Neonatal Resuscitation.

  • Data_Sheet_1_RETAIN: A Board Game That Improves Neonatal Resuscitation Knowledge Retention.docx
    2019
    Co-Authors: Maria Cutumisu, Matthew R. G. Brown, Caroline Fray, Siddhi D. Patel, Patrick Von Hauff, Thomas Jeffery, Georg M. Schmölzer
    Abstract:

    Background: The current Resuscitation guidelines recommend frequent simulation based medical education (SBME). However, the current SBME approach is expensive, time-intensive, and requires a specialized lab and trained instructors. Hence, it is not offered routinely at all hospitals. We designed the board game “RETAIN” to train healthcare providers (HCPs) in Neonatal Resuscitation in a cost-friendly and accessible way.Objectives: To examine if a board game-based training simulator improves knowledge retention in HCPs.Methods: “RETAIN” consists of a board using an image of a baby, visual objects, adjustable timer, monitors, and action cards. Neonatal HCPs at the Royal Alexandra Hospital were invited to participate. Participants completed a written pre-test (Resuscitation of a 24-week infant), then played the board game (starting with a tutorial followed by free playing of three evidence-based Neonatal Resuscitation scenarios). Afterwards, a post-test with the same Resuscitation scenario and an opinion survey was completed. The answers from the pre- and post-test were compared to assess HCPs' knowledge retention.Results: Thirty HCPs (four doctors, 12 nurses, and 14 respiratory therapist) participated in the study. Overall, we observed a 10% increase in knowledge retention between the pre- and post-test (49–59%, respectively). Temperature management showed the most knowledge gain between the pre- and post-test (14–46%, respectively). Placement of a hat (10–43%), plastic wrap (27–67%), and temperature probe (7–30%) improved between the pre- and post-test.Conclusion: Knowledge retention increased by 12% between pre- and post-test (49–61%, respectively). The improvement in performance and knowledge supports the use of board game simulations for clinical training.

  • Growth Mindset Moderates the Effect of the Neonatal Resuscitation Program on Performance in a Computer-Based Game Training Simulation.
    Frontiers in pediatrics, 2018
    Co-Authors: Maria Cutumisu, Matthew R. G. Brown, Caroline Fray, Georg M. Schmölzer
    Abstract:

    This study examines for the first time the moderating role of growth mindset on the association between the time elapsed since participants' last refresher Neonatal Resuscitation program (NRP) course and their performance on Neonatal Resuscitation tasks in the RETAIN computer game training simulation. Participants were n = 50 health-care providers affiliated with a large university hospital. Results revealed that growth mindset moderated the relation between participants' task performance in the game and the time since their latest refresher NRP course. Specifically, participants who completed the course more recently (i.e., between 8 and 9 months before the current study) made significantly more mistakes in the game than the rest of the participants but only when they endorsed lower levels of growth mindset. Implications of this research include growth mindset interventions and increased screen time in simulation sessions that have the potential to help health-care providers achieve better performance on Neonatal Resuscitation clinical tasks.

Gary M Weiner - One of the best experts on this subject based on the ideXlab platform.

  • time perception during Neonatal Resuscitation
    The Journal of Pediatrics, 2016
    Co-Authors: Daniele Trevisanuto, Giuseppe De Bernardo, Giulia Res, Desiree Sordino, Nicoletta Doglioni, Gary M Weiner, Francesco Cavallin
    Abstract:

    Objective To assess the accuracy of time perception during a simulated complex Neonatal Resuscitation. Study design Participants in 5 Neonatal Resuscitation program courses were directly involved in a complex simulation scenario. They were asked to assume the role of team leader, assistant 1, or assistant 2. At the end of the scenario, each participant completed a questionnaire on perceived time intervals for key Resuscitation interventions. During the scenario, actual times were documented by an external observer and video recorded for later review. In addition, participants were asked to evaluate their self-perceived level of stress and preparation. Results Health care providers (68 physicians and 40 nurses) were involved in 36 scenarios. Perceived time intervals for the initiation of key Resuscitation interventions were shorter than the actual time intervals, regardless of the participant's role in the scenario. Self-assessed levels of stress and preparation did not influence time perception. Conclusions Health care providers underestimate the passage of time, irrespective of their role in a simulated complex Neonatal Resuscitation. Participant's self-assessed levels of stress and preparation were not related to the accuracy of their time perception. These findings highlight the importance of assigning a dedicated individual to document interventions and the passage of time during a Neonatal Resuscitation.

  • the development and testing of a performance checklist to assess Neonatal Resuscitation megacode skill
    Pediatrics, 2006
    Co-Authors: Jocelyn Lockyer, Gary M Weiner, Nalini Singhal, Herta Fidler, Khalid Aziz, Vernon Curran
    Abstract:

    PURPOSE. The purpose of this work was to develop and assess the feasibility, reliability, and validity of a brief performance checklist to evaluate skills during a simulated Neonatal Resuscitation (“megacode”) for the Neonatal Resuscitation Program of the American Academy of Pediatrics. METHODS. A performance checklist of items was created, validated, and modified in sequential phases involving: an expert committee, review, and feedback by Neonatal Resuscitation Program instructors for feasibility and criticality and use of the performance checklist by Neonatal Resuscitation Program instructors reviewing videotaped megacodes. The final 20-item performance checklist used a 3-point scale and was assessed by student and instructor volunteers. Megacode scores, the NRP multiple-choice examination scores, student assessments of their ability and performance, and sociodemographic descriptors for both students and instructors were collected. Data were analyzed descriptively. In addition, we assessed the megacode score internal consistency reliability, the correlations between megacode and multiple-choice examination scores, and the variance in scores based on instructor and student characteristics. RESULTS. A total of 468 students and 148 instructors volunteered for the study. The instrument was reliable and internally consistent. Student9s scores were high on most items. There was a significant but low correlation between the megacode score and the written knowledge examination. Instructor and student characteristics had little effect on the variance in scores. CONCLUSIONS. This performance checklist provides a feasible assessment tool. There is evidence for its reliability and validity.

  • laryngeal mask airway versus bag mask ventilation or endotracheal intubation for Neonatal Resuscitation
    Cochrane Database of Systematic Reviews, 2005
    Co-Authors: Andrew J Grein, Gary M Weiner
    Abstract:

    Background Providing effective positive pressure ventilation is the single most important component of successful Neonatal Resuscitation. Ventilation is frequently initiated with a manual Resuscitation bag and face-mask (BMV) followed by endotracheal intubation (ETT) if depression continues. These techniques may be difficult to perform successfully resulting in prolonged Resuscitation or severe Neonatal depression. The laryngeal mask airway (LMA) may achieve initial ventilation and successful Resuscitation faster than a bag-mask device or endotracheal intubation. Objectives Among newborns requiring positive pressure ventilation for Resuscitation, is effective ventilation and successful Resuscitation achieved faster with the LMA compared with either BMV or ETT? Search methods The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2004), MEDLINE (1966-November 2004), Pre-MEDLINE (November 15, 2004), CINAHL 1982-November 2004), reference lists of published trials, and Society for Pediatric Research abstracts were searched. Experts were contacted for additional references. Selection criteria Randomised and quasi-randomised trials Data collection and analysis Two reviewers independently evaluated studies, assessed methodologic quality, and extracted data using the Cochrane Neonatal Review Group criteria. Categorical treatment effects were described as relative risks and risk differences and continuous treatment effects were described as the mean difference. There were insufficient data to perform pooled analyses. Main results No eligible studies compared the LMA with BMV. One small randomised controlled trial comparing the LMA with ETT when BMV had been unsuccessful was included. There was no statistically significant difference between the LMA and ETT with the exception of a clinically insignificant difference in time to complete insertion of the device favouring the ETT. Authors' conclusions The LMA can achieve effective ventilation during Neonatal Resuscitation in a time-frame consistent with current guidelines. There is no evidence to evaluate the relative efficacy and safety of the LMA compared with BMV as the primary airway device. A single, small randomised controlled trial found no clinically significant difference between the LMA and ETT when BMV was unsuccessful. Case series and case reports suggest that the LMA can provide an effective rescue airway during Resuscitation if both BMV and ETT have been unsuccessful. A well-designed randomised controlled trial comparing the LMA with BMV during Neonatal Resuscitation is warranted.

Susan Niermeyer - One of the best experts on this subject based on the ideXlab platform.

  • Neonatal Resuscitation in global health settings an examination of the past to prepare for the future
    Pediatric Research, 2017
    Co-Authors: Beena D Kamathrayne, Kc Ashish, Sara K Berkelhamer, Hege Langli Ersdal, Susan Niermeyer
    Abstract:

    As rates of childhood mortality decline, Neonatal deaths account for nearly half of under-5 deaths worldwide. Intrapartum-related events (birth asphyxia) contribute to approximately one-quarter of Neonatal deaths, many of which can be prevented by simple Resuscitation and newborn care interventions. This paper reviews various lines of research that have influenced the global Neonatal Resuscitation landscape. A brief situational analysis of asphyxia-related newborn mortality in low-resource settings is linked to renewed efforts to reduce Neonatal mortality in the Every Newborn Action Plan. Possible solutions to gaps in care are identified. Building on international scientific evidence, tests of educational efficacy, and community-based trials established the feasibility and effectiveness of training in resource-limited settings and identified successful implementation strategies. Implementation of Neonatal Resuscitation programs has been shown to decrease intrapartum stillbirth rates and early Neonatal mortality. Challenges remain with respect to provider competencies, coverage, and quality of interventions. The combination of Resuscitation science, strategies to increase educational effectiveness, and implemention of interventions with high coverage and quality has resulted in reduced rates of asphyxia-related Neonatal mortality. Further efforts to improve coverage and implementation of Neonatal Resuscitation will be necessary to meet the 2035 goal of eliminating preventable newborn deaths.

  • from the Neonatal Resuscitation program to helping babies breathe global impact of educational programs in Neonatal Resuscitation
    Seminars in Fetal & Neonatal Medicine, 2015
    Co-Authors: Susan Niermeyer
    Abstract:

    Two educational programs in Neonatal Resuscitation, the Neonatal Resuscitation Program (NRP) and Helping Babies Breathe (HBB) have found widespread acceptance globally as practical tools to improve newborn survival and reduce death from perinatal asphyxia. The programs share a common scientific evidence base and both employ adult education principles with an emphasis on building skills. However, they differ in their target audience and context, their core content, and the methods used for knowledge translation. This review describes how the design of NRP transported it outside the USA to countries around the globe and how the program has contributed to improvements in care at multiple levels from the bedside to guidelines and research. It examines the gaps in the reach of NRP that stimulated the development of HBB and helped shape a different approach to education of health care providers in resource-limited settings. Implementation of HBB is summarized to date, and evidence provided of its effectiveness in reducing Neonatal death and stillbirth. Finally, consideration of how the programs function together suggests their future potential to strengthen health systems and maximize the impact on the health of newborns.

  • basic newborn care and Neonatal Resuscitation a multi country analysis of health system bottlenecks and potential solutions
    BMC Pregnancy and Childbirth, 2015
    Co-Authors: Christabel Enweronularyea, Susan Niermeyer, Sarah G Moxon, Kim E Dickson, Aline Simenkapeu, Christabel Nyange, Howard L Sobel, Anne C C Lee
    Abstract:

    An estimated two-thirds of the world's 2.7 million newborn deaths could be prevented with quality care at birth and during the postnatal period. Basic Newborn Care (BNC) is part of the solution and includes hygienic birth and newborn care practices including cord care, thermal care, and early and exclusive breastfeeding. Timely provision of Resuscitation if needed is also critical to newborn survival. This paper describes health system barriers to BNC and Neonatal Resuscitation and proposes solutions to scale up evidence-based strategies. The maternal and newborn bottleneck analysis tool was applied by 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks" that hinder the scale up of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for BNC and Neonatal Resuscitation. Eleven of the 12 countries provided grading data. Overall, bottlenecks were graded more severely for Resuscitation. The most severely graded bottlenecks for BNC were health workforce (8 of 11 countries), health financing (9 out of 11) and service delivery (7 out of 9); and for Neonatal Resuscitation, workforce (9 out of 10), essential commodities (9 out of 10) and service delivery (8 out of 10). Country teams from Africa graded bottlenecks overall more severely. Improving workforce performance, availability of essential commodities, and well-integrated health service delivery were the key solutions proposed. BNC was perceived to have the least health system challenges among the seven maternal and newborn intervention packages assessed. Although Neonatal Resuscitation bottlenecks were graded more severe than for BNC, similarities particularly in the workforce and service delivery building blocks highlight the inextricable link between the two interventions and the need to equip birth attendants with requisite skills and commodities to assess and care for every newborn. Solutions highlighted by country teams include ensuring more investment to improve workforce performance and distribution, especially numbers of skilled birth attendants, incentives for placement in challenging settings, and skills-based training particularly for Neonatal Resuscitation.

Manoj Kumar - One of the best experts on this subject based on the ideXlab platform.

  • laryngeal mask airway versus bag mask ventilation or endotracheal intubation for Neonatal Resuscitation
    Cochrane Database of Systematic Reviews, 2018
    Co-Authors: Mosarrat Qureshi, Manoj Kumar
    Abstract:

    Background Providing effective positive pressure ventilation is considered to be the single most important component of successful Neonatal Resuscitation. Ventilation is frequently initiated manually with bag and face mask (BMV) followed by endotracheal intubation if respiratory depression continues. These techniques may be difficult to perform successfully resulting in prolonged Resuscitation or Neonatal asphyxia. The laryngeal mask airway (LMA) may achieve initial ventilation and successful Resuscitation faster than a bag-mask device or endotracheal intubation. Objectives Among newborns requiring positive pressure ventilation for cardio-pulmonary Resuscitation, is LMA more effective than BMV or endotracheal intubation for successful Resuscitation? When BMV is either insufficient or ineffective, is effective positive pressure ventilation and successful Resuscitation achieved faster with the LMA compared to endotracheal intubation? Search methods We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2017, Issue 1), MEDLINE via PubMed (1966 to 15 February 2017), Embase (1980 to 15 February 2017), and CINAHL (1982 to 15 February 2017). We also searched clinical trials registers, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. Selection criteria We included randomised and quasi-randomised controlled trials that compared LMA for Neonatal Resuscitation with either BMV or endotracheal intubation and reported on any outcomes related to Neonatal Resuscitation specified in this review. Data collection and analysis Two review authors independently evaluated studies for risk of bias assessments, and extracted data using Cochrane Neonatal criteria. Categorical treatment effects were described as relative risks and continuous treatment effects were described as the mean difference, with 95% confidence intervals (95% CI) of estimates. Main results We included seven trials that involved a total of 794 infants. Five studies compared LMA with BMV and three studies compared LMA with endotracheal intubation. We added six new studies for this update (754 infants).LMA was associated with less need for endotracheal intubation than BMV (typical risk ratio (RR) 0.24, 95% CI 0.12 to 0.47 and typical risk difference (RD) -0.14, 95% CI -0.14 to -0.06; 5 studies, 661 infants; moderate-quality evidence) and shorter ventilation time (mean difference (MD) -18.90 seconds, 95% CI -24.35 to -13.44; 4 studies, 610 infants). Babies resuscitated with LMA were less likely to require admission to Neonatal intensive care unit (NICU) (typical RR 0.60, 95% CI 0.40 to 0.90 and typical RD -0.18, 95% CI -0.31 to -0.04; 2 studies,191 infants; moderate-quality evidence). There was no difference in deaths or hypoxic ischaemic encephalopathy (HIE) events.Compared to endotracheal intubation, there were no clinically significant differences in insertion time or failure to correctly insert the device (typical RR 0.95, 95% CI 0.17 to 5.42; 3 studies, 158 infants; very low-quality evidence). There was no difference in deaths or HIE events. Authors' conclusions LMA can achieve effective ventilation during Neonatal Resuscitation in a time frame consistent with current Neonatal Resuscitation guidelines. Compared to BMV, LMA is more effective in terms of shorter Resuscitation and ventilation times, and less need for endotracheal intubation (low- to moderate-quality evidence). However, in trials comparing LMA with BMV, over 80% of infants in both trial arms responded to the allocated intervention. In studies that allowed LMA rescue of infants failing with BMV, it was possible to avoid intubation in the majority. It is important that the clinical community resorts to the use of LMA more proactively to provide effective ventilation when newborn is not responding to BMV before attempting intubation or initiating chest compressions.LMA was found to offer comparable efficacy to endotracheal intubation (very low- to low-quality evidence). It therefore offers an alternate airway device when attempts at inserting endotracheal intubation are unsuccessful during Resuscitation.Most studies enrolled infants with birth weight over 1500 g or 34 or more weeks' gestation. As such, there is lack of evidence to support LMA use in more premature infants.

Dharmapuri Vidyasagar - One of the best experts on this subject based on the ideXlab platform.

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