The Role of Simulation in Health Education Globally: A Review of the Neonatal Resuscitation Program and Helping Babies Breathe

2018 ◽  
pp. 201-217
Author(s):  
Beena D. Kamath-Rayne ◽  
Michael K. Visick ◽  
Sara K. Berkelhamer
Keyword(s):  
Neonatal Mortality ◽  
Professional Education ◽  
Life Support ◽  
Teaching Strategy ◽  
Low Cost ◽  
Neonatal Resuscitation ◽  
Helping Babies Breathe ◽  
Refresher Training ◽  
Simulation Based ◽  
Neonatal Resuscitation Program

In 2010, the Neonatal Resuscitation Program became the first life support resuscitation program to formally incorporate simulation- based training with debriefing as an educational methodology. Concurrently, a simplified simulation-based neonatal resuscitation program called Helping Babies Breathe (HBB) was created, with the goal of providing low-cost, portable programming to teach basic neonatal resuscitation to birth attendants in low- and middle-income countries. Early studies evaluating the efficacy of HBB demonstrated that facility- based implementation has the potential to reduce rates of early (<24 hour) neonatal mortality and stillbirth. Subsequent investigations that have coupled HBB training with quality improvement efforts, ongoing practice, and refresher training have shown even greater effect on neonatal mortality and stillbirth rates. However, the ideal frequency of skills practice and refresher training required to retain resuscitation skills remains poorly defined. Challenges exist in defining optimal practices, as recommendations may vary by the cadre of health care professional, education level, and access to ongoing delivery room experience. While simulation-based strategies have been shown to be effective at improving educational and clinical outcomes, the use of simulation in global health settings is challenged by hurdles such as resource limitations (complex equipment, supply chain, and expense), time intensity, dependence on skilled educators, and acceptance of simulation as a teaching strategy.

scholarly journals Revisiting: “A pre-post study of a multi-country scale up of resuscitation training of facility birth attendants: does helping babies breathe training save lives?”

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sara Berkelhamer ◽  
Nalini Singhal
Keyword(s):  
Neonatal Mortality ◽  
Low Cost ◽  
Scale Up ◽  
Neonatal Resuscitation ◽  
Population Level ◽  
Helping Babies Breathe ◽  
Birth Attendants ◽  
Resuscitation Training ◽  
Facility Birth ◽  
The Impact

Abstract Background Helping Babies Breathe (HBB) is a low cost, skills-based neonatal resuscitation education program designed specifically for use in low resource settings. Studies from Tanzania, India and Nepal have demonstrated that HBB training results in decreased rates of fresh still birth and/or neonatal mortality. However, less is known regarding the impact of training on neonatal mortality at a population level. Bellad et al. utilized (BMC Pregnancy Childbirth. 2016;16 (1):222) utilized population based registries to evaluate outcomes before and after training of facility birth attendants. Their study entitled “A pre-post study of a multi-country scale up of resuscitation training of facility birth attendants: Does Helping Babies Breathe training save lives?” suggested facility based training was not associated with consistent improvements in neonatal mortality on a population level. Discussion Combining outcomes from three diverse settings may have under-estimated the impact of HBB training. We remain concerned that the modest benefits observed in the Kenyan site were lost with compiling of data. Summary The statement that HBB “was not associated with consistent improvements in mortality” may lead to the mistaken conclusion that improvements in neonatal mortality were not seen, when in fact, they were in selected cohorts. With numerous studies demonstrating potential for reduced neonatal mortality as a result of HBB training, we encourage interpretation of these findings in the context of local care.

scholarly journals Helping Babies Breathe and its effects on intrapartum-related stillbirths and neonatal mortality in low-resource settings: a systematic review

2019 ◽  
pp. archdischild-2018-316319 ◽  
Author(s):  
Jorien M D Versantvoort ◽  
Mirjam Y Kleinhout ◽  
Henrietta D L Ockhuijsen ◽  
Kitty Bloemenkamp ◽  
Willem B de Vries ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neonatal Mortality ◽  
Data Extraction ◽  
Neonatal Resuscitation ◽  
Eligibility Criteria ◽  
Low Resource Settings ◽  
Low Resource ◽  
Helping Babies Breathe ◽  
Simulation Based ◽  
Registration Number

BackgroundAn important factor in worldwide neonatal mortality is the deficiency in neonatal resuscitation skills among trained professionals. ‘Helping Babies Breathe’ (HBB) is a simulation-based training course designed to train healthcare professionals in the initial steps of neonatal resuscitation in low-resource areas. The aim of this systematic review is to provide an overview of the available evidence regarding intrapartum-related stillbirths and neonatal mortality related to the HBB training and resuscitation method.Data sourcesCochrane, CINAHL, Embase, PubMed and Scopus.Study eligibility criteriaConducted in low-resource settings focusing on the effects of HBB on intrapartum-related stillbirths and neonatal mortality.Study appraisalIncluded studies were reviewed independently by two researchers in terms of methodological quality.Data extractionData were extracted by two independent reviewers and crosschecked by one additional reviewer.ResultsSeven studies were included in this systematic review; the selected studies included a total of 230.797 neonates. Significant decreases were found after the implementation of HBB in one of two studies describing perinatal mortality (n=25 108, rate ratio (RR) 0.75; p<0.001), four out of six studies related to intrapartum-related stillbirths (n=125.720, RR 0.31–0.76), in four out of five studies focusing on 1 day neonatal mortality (n=111.289, RR 0.37–0.67), and one out of three studies regarding 7 day neonatal mortality (n=4.390, RR 0.32). No changes were seen in late neonatal mortality after HBB training and resuscitation method.LimitationsIncluded studies in were predominantly of moderate quality, therefore no strong recommendations can be made.Conclusions and implications of key findingsDue to the heterogeneous quality of the studies, this systematic review showed moderate evidence for a decrease in intrapartum-related stillbirth and 1-day neonatal mortality rate after implementing the ‘Helping Babies Breathe’ training and resuscitation method. Further research is required to address the effects of simulation-based team training on morbidity and mortality beyond the initial neonatal period.PROSPERO registration numberCRD42018081141.

Code Blue Events in the Neonatal and Pediatric Intensive Care Units at a Tertiary Care Children's Hospital

2020 ◽  
Author(s):  
Catherine M. Groden ◽  
Erwin T. Cabacungan ◽  
Ruby Gupta
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Life Support ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Neonatal Resuscitation ◽  
Advanced Life Support ◽  
Pediatric Intensive Care ◽  
Code Blue ◽  
Neonatal Resuscitation Program

Objective The authors aim to compare all code blue events, regardless of the need for chest compressions, in the neonatal intensive care unit (NICU) versus the pediatric intensive care unit (PICU). We hypothesize that code events in the two units differ, reflecting different disease processes. Study Design This is a retrospective analysis of 107 code events using the code narrator, which is an electronic medical record of real-time code documentation, from April 2018 to March 2019. Events were divided into two groups, NICU and PICU. Neonatal resuscitation program algorithm was used for NICU events and a pediatric advanced life-support algorithm was used for PICU events. Events and outcomes were compared using univariate analysis. The Mann–Whitney test and linear regressions were done to compare the total code duration, time from the start of code to airway insertion, and time from airway insertion to end of code event. Results In the PICU, there were almost four times more code blue events per month and more likely to involve patients with seizures and no chronic condition. NICU events more often involved ventilated patients and those under 2 months of age. The median code duration for NICU events was 2.5 times shorter than for PICU events (11.5 vs. 29 minutes), even when adjusted for patient characteristics. Survival to discharge was not different in the two groups. Conclusion Our study suggests that NICU code events as compared with PICU code events are more likely to be driven by airway problems, involve patients <2 months of age, and resolve quickly once airway is taken care of. This supports the use of a ventilation-focused neonatal resuscitation program for patients in the NICU. Key Points

scholarly journals Evaluating Neonatal Resuscitation Skills of Practicing Nurses and Midwives in Selected Hospitals in Central Uganda​

2020 ◽  
Author(s):  
Mary Namuguzi ◽  
Karen Drake ◽  
Elizabeth Namukombe Ekong ◽  
Ekaete FRANCIS Asuquo
Keyword(s):  
Mortality Rate ◽  
Neonatal Mortality ◽  
Neonatal Resuscitation ◽  
The State ◽  
Neonatal Mortality Rate ◽  
Successful Resuscitation ◽  
Knowledge And Skills ◽  
Helping Babies Breathe ◽  
Regulatory Policies ◽  
Nurses And Midwives

Abstract Background: Uganda has a high neonatal mortality rate (27 per 1,000 live births), with birth asphyxia as one of the major contributor. Helping babies breathe (HBB) is an evidence-based program that aims to reduce neonatal mortality in resource-limited settings. Successful resuscitation depends on nurses’ and midwives’ knowledge and skills in neonatal resuscitation, and access to functional neonatal resuscitation equipment. This study aimed to evaluate knowledge and skills retention in neonatal resuscitation after HBB training among nurses and midwives, and the state/availability of neonatal resuscitation equipment. Methods: This study used a cross sectional design. Participants were 75 nurses and midwives from two hospitals in Central Uganda. Data were collected using questionnaires and observation checklists. Ethics approval was obtained from the Uganda Christian University and the research and ethics committees of the two hospital hospitals. Results: Nurses and midwives showed a high level of knowledge (92%). However, neonatal resuscitation skills among 44 observed participants were poor, as 68.2% failed to check equipment and select the correct mask and 45.5% did not make a firm seal when applying the mask. In addition, about 72% of participants did not ventilate at a rate of 40 breaths per minute, and 18.2% failed to assess chest movement. Observation of 44 resuscitations to evaluate the state/availability of neonatal resuscitation equipment showed that 27.3% did not have a suction device, 59.1% did not have a heat source/pre-warmed towels to warm the babies, 50% did not have appropriate self-inflating bags and masks for term and preterm babies, 72.7% had no clock/watch to count heart rate and determine the length of time ventilation was required, and 36.4% did not document that resuscitation was performed. Conclusions: To address Uganda’s neonatal mortality rate, it is necessary to implement regulatory policies for neonatal resuscitation, building nurses and midwives skills for active interventions during neonatal resuscitation as well as regular refresher courses to enhance skills. Key words: helping babies breathe (HBB), neonatal resuscitation, knowledge, skills and equipment

NRP Versus PALS for Infants Outside the Delivery Room: Not If, but When?

2021 ◽  
Vol 41 (6) ◽  
pp. 22-27
Author(s):  
Jaime Esbensen Doroba
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Life Support ◽  
Neonatal Resuscitation ◽  
Advanced Life Support ◽  
Delivery Room ◽  
Background Information ◽  
Neonatal Resuscitation Program ◽  
Support Guidelines

Background Both the Neonatal Resuscitation Program and Pediatric Advanced Life Support guidelines can be used for infants requiring cardiopulmonary resuscitation outside the delivery room. Each set of guidelines has supporting algorithms for resuscitation; however, there are no current recommendations for transitioning older infants outside the delivery room. Objective To provide background information on the algorithms in the Neonatal Resuscitation Program and Pediatric Advanced Life Support guidelines and to discuss the role that nurses and advanced practice nurses play in advancing scientific research on resuscitation. Content Covered Summaries of both sets of guidelines, differences in practices, and recommendations for practice changes will be discussed. Discussion Provider preference and unit practice determine which guidelines are used for infants outside the delivery room. Providers in pediatric intensive care units and pediatric cardiac intensive care units often use the Pediatric Advanced Life Support guidelines, whereas providers in neonatal intensive care units use the Neonatal Resuscitation Program guidelines for infants of the same age. The variation in resuscitation practices for infants outside the delivery room can negatively affect resuscitation outcomes.

scholarly journals Cost-Effective Extracorporeal Membrane Oxygenation Simulation

2018 ◽  
Vol 02 (01) ◽  
pp. 005-009 ◽  
Author(s):  
Guillaume Alinier
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Best Practice ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Low Cost ◽  
Cost Effective ◽  
Emergency Situations ◽  
Membrane Oxygenation ◽  
Ensure Patient Safety ◽  
Simulation Based

AbstractThis invited review article was presented orally on the occasion of the South West Asian Chapter conference of the Extracorporeal Life Support Organization (ELSO) held in New Delhi, India in January 2018. It has an educational focus on the topic of extracorporeal membrane oxygenation (ECMO), which is increasingly being used as a lifesaving bridge therapy. A case is being made regarding the adage “practice makes perfect” to be considered in the context of simulation-based education to ensure patient safety. Technology-enhanced simulation-based deliberate practice should be used more commonly to support clinicians in the development of all their professional skills. This is an ethical imperative that may be addressed using low-cost simulation modalities that are sometimes proven to be as effective as more expensive approaches. Educators can now design their programs according to published best practice standards for the benefit of their learners, and ultimately the patients they care for. Simulation-based education clearly has a place and important role to play in preparing ECMO teams dealing with routine procedures as well as emergency situations. Several solution and approaches are being presented alongside innovative work currently being done in collaboration between a regional ELSO center of excellence and an academic institution. This innovative simulator is composed of several modules serving different functions required for the simulation of ECMO emergencies at a much lower cost than using the real machine and its various expensive disposable components.

scholarly journals Knowledge of General Practitioner Doctors and Midwives Who Has and Has Not Attended Neonatal Resuscitation Course Has No Significant Difference

2020 ◽  
Vol 1 (2) ◽  
pp. 38
Author(s):  
Vincent Geraldus Enoch Lusida ◽  
Bambang Puijo Semedi ◽  
Bambang Herwanto
Keyword(s):  
General Practitioners ◽  
Life Support ◽  
Health Workers ◽  
Neonatal Resuscitation ◽  
Newborn Care ◽  
Contributing Factors ◽  
Cross Sectional ◽  
Resuscitation Training ◽  
Significant Difference ◽  
Neonatal Resuscitation Program

Introduction: Infant death is most prominent in the neonatal period. The success of neonatal resuscitation practice has many contributing factors. One of which is the health workers’ knowledge of the Neonatal Resuscitation Program (NRP) algorithm. Therefore, it is necessary to conduct studies to evaluate the health workers’ knowledge of the Neonatal Resuscitation Program who are educated in neonatal resuscitation course and has taken part in Neonatal Life Support practice in primary health care (PHC)  Objective: This study aims to analyze the knowledge of general practitioners and midwives who has or has not attended in neonatal resuscitation course in Surabaya PHC Methods and Materials: this research is descriptive, cross-sectional research. All Basic Emergency Obstetric and Newborn Care (BEmONC) PHC in Surabaya which are Jagir PHC, Banyu Urip PHC, Medokan Ayu PHC, Tanah kali Kedinding PHC, Tanjungsari PHC, Balongsari PHC, Sememi PHC, Simomulyo PHC is included in this research from 2018 to 2019. A nine-item questionnaire referenced from The Textbook of Neonatal Resuscitation 7th Edition is given to ten respondents in each BEmONC PHC. Results and Discussion: from the total sample of 78 respondents, 32 (41,0%) receive a high score, 20 (25,7%) receive a middle score, and 26 (33,3%) receive a low score. The data shows that there is no significant score difference between respondents who has or has not participate in the NRP course (p=0,419). Conclusion:  There is no correlation between difference knowledge midwives and general practitioners who had and had not attended neonatal resuscitation training at basic emergency obstetric and newborn care in public health center Surabaya.

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