scholarly journals Pediatrics Residents' Preparedness for Neonatal Resuscitation Assessed Using High-Fidelity Simulation

2013 ◽  
Vol 5 (3) ◽  
pp. 399-404 ◽  
Author(s):  
Leandro Cordero ◽  
Brandon J. Hart ◽  
Rene Hardin ◽  
John D. Mahan ◽  
Peter J. Giannone ◽  
...  
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Neonatal Resuscitation ◽  
Delivery Room ◽  
Positive Pressure ◽  
High Fidelity ◽  
Procedural Skill ◽  
Actual Performance ◽  
Self Confidence ◽  
Skill Performance

Abstract Background Pediatrics residents are expected to demonstrate preparedness for neonatal resuscitation, yet research has shown gaps in residents' readiness to perform this skill. Objective To evaluate procedural skills and team performance of pediatrics residents during neonatal resuscitation (NR) using a high-fidelity mannequin, and to assess residents' confidence in their NR skills before and after training. Methods Two teams of residents (all had completed NR program training) participated in 2 separate, 90-minute sessions (2 to 3 weeks apart) in an off-site delivery room during their neonatal intensive care rotation. Residents' confidence in assisting and leading NR was surveyed before each session. Teams participated in a scenario (adapted from the NR program), which required 5 skills (positive pressure ventilation, chest compressions, endotracheal intubation, umbilical vein catheterization, and epinephrine administration). Video recording was used for debriefing and scoring. Skills were scored for technique and timeliness, and team behaviors were scored for communication, management, and leadership. Results Twenty-six residents (11 teams) completed 2 paired sessions. Self-confidence scores increased between the 2 sessions but were not correlated with performance. Gaps in procedural skill performance were observed, and timeliness for most skills did not meet expectations. Significant improvement in team communication was noted. Conclusions Important gaps in procedural skill performance, particularly timeliness, were detected by NR simulation training; residents' improvements in self-confidence did not reflect gains in actual performance. Their relative unpreparedness for NR (despite prior certification) highlights the need for deliberate practice and specific team training before and during neonatal intensive care delivery room rotations.

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 Evaluating the use of high-fidelity simulators during mock neonatal resuscitation scenarios in trying to improve confidence in residents

2018 ◽  
Vol 6 ◽  
pp. 205031211878195 ◽  
Author(s):  
Deena Hossino ◽  
Christina Hensley ◽  
Karen Lewis ◽  
Marie Frazier ◽  
Renee Domanico ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Neonatal Resuscitation ◽  
Venous Catheter ◽  
Respiratory Arrest ◽  
High Fidelity ◽  
High Fidelity Simulation ◽  
Post Intervention ◽  
Self Confidence ◽  
Simulation Based ◽  
Multiple Scenarios

Objective: The purpose of this study was to investigate the effect of the use of high-fidelity simulators with multidisciplinary teaching on self-reported confidence in residents. Methods: A total of 26 residents participated in a session led by a pediatric faculty member and a Neonatal Intensive Care Unit transport nurse using a high-fidelity pediatric simulator. Multiple scenarios were presented and each resident took turns in various roles. Pre-intervention surveys based on a 5-point Likert-type scale were given before the scenarios and were compared to the results of identical post-intervention surveys. Results: Statistically significant (p < 0.05) pre to post gains for self-confidence were observed. Improvements in confidence were analyzed using the mean difference. The largest improvement in confidence was seen in the ability to treat neonatal respiratory arrest. This was followed by the ability to supervise/run a code, and the ability to place an umbilical venous catheter. Conclusion: These results revealed that high-fidelity simulation-based training has significant positive gains in residents’ self-reported confidence.

scholarly journals Short- and Intermediate-Term Outcomes of Preterm Infants Receiving Positive Pressure Ventilation in the Delivery Room

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Megan O'Reilly ◽  
Po-Yin Cheung ◽  
Khalid Aziz ◽  
Georg M. Schmölzer
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Positive Pressure Ventilation ◽  
Survival Rates ◽  
Delivery Room ◽  
Positive Pressure ◽  
Protective Strategy ◽  
Residual Capacity ◽  
Ventilation Strategies

Although recent advances in neonatal care have improved survival rates, rates of bronchopulmonary dysplasia remain unchanged. Although neonatologists are increasingly applying gentle ventilation strategies in the neonatal intensive care unit, the same emphasis has not been applied immediately after birth. A lung-protective strategy should start with the first breath to help in the establishment of functional residual capacity, facilitate gas exchange, and reduce volutrauma and atelectotrauma. This paper will discuss techniques and equipment during breathing assistance in the delivery room.

scholarly journals Characterisation of Textile Embedded Electrodes for Use in a Neonatal Smart Mattress Electrocardiography System

Sensors ◽  
2021 ◽  
Vol 21 (3) ◽  
pp. 999
Author(s):  
Henry Dore ◽  
Rodrigo Aviles-Espinosa ◽  
Zhenhua Luo ◽  
Oana Anton ◽  
Heike Rabe ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Heart Rate ◽  
Intensive Care ◽  
High Resolution ◽  
Neonatal Intensive Care Unit ◽  
Real Time ◽  
Neonatal Intensive Care ◽  
Delivery Room ◽  
Proof Of Concept ◽  
Heart Rate Monitoring

Heart rate monitoring is the predominant quantitative health indicator of a newborn in the delivery room. A rapid and accurate heart rate measurement is vital during the first minutes after birth. Clinical recommendations suggest that electrocardiogram (ECG) monitoring should be widely adopted in the neonatal intensive care unit to reduce infant mortality and improve long term health outcomes in births that require intervention. Novel non-contact electrocardiogram sensors can reduce the time from birth to heart rate reading as well as providing unobtrusive and continuous monitoring during intervention. In this work we report the design and development of a solution to provide high resolution, real time electrocardiogram data to the clinicians within the delivery room using non-contact electric potential sensors embedded in a neonatal intensive care unit mattress. A real-time high-resolution electrocardiogram acquisition solution based on a low power embedded system was developed and textile embedded electrodes were fabricated and characterised. Proof of concept tests were carried out on simulated and human cardiac signals, producing electrocardiograms suitable for the calculation of heart rate having an accuracy within ±1 beat per minute using a test ECG signal, ECG recordings from a human volunteer with a correlation coefficient of ~ 87% proved accurate beat to beat morphology reproduction of the waveform without morphological alterations and a time from application to heart rate display below 6 s. This provides evidence that flexible non-contact textile-based electrodes can be embedded in wearable devices for assisting births through heart rate monitoring and serves as a proof of concept for a complete neonate electrocardiogram monitoring system.

scholarly journals Accuracy of real-time delivery room resuscitation documentation

2018 ◽  
Vol 105 (2) ◽  
pp. 222-224 ◽  
Author(s):  
Claire E Fishman ◽  
Danielle D Weinberg ◽  
Ashley Murray ◽  
Elizabeth E Foglia
Keyword(s):  
Heart Rate ◽  
Oxygen Saturation ◽  
Real Time ◽  
Vital Sign ◽  
Gold Standard ◽  
Neonatal Intensive Care ◽  
Video Recording ◽  
Neonatal Resuscitation ◽  
Delivery Room ◽  
Level 3

ObjectiveTo assess the accuracy of real-time delivery room resuscitation documentation.DesignRetrospective observational study.SettingLevel 3 academic neonatal intensive care unit.ParticipantsFifty infants with video recording of neonatal resuscitation.Main outcome measuresVital sign assessments and interventions performed during resuscitation. The accuracy of written documentation was compared with video gold standard.ResultsTiming of initial heart rate assessment agreed with video in 44/50 (88%) records; the documented heart rate was correct in 34/44 (77%) of these. Heart rate and oxygen saturation were documented at 5 min of life in 90% of resuscitations. Of these, 100% of heart rate and 93% of oxygen saturation values were correctly recorded. Written records accurately reflected the mode(s) of respiratory support for 89%–100%, procedures for 91%–100% and medications for 100% of events.ConclusionReal-time documentation correctly reflects interventions performed during delivery room resuscitation but is less accurate for early vital sign assessments.

scholarly journals Novel Neonatal Simulator Provides High-Fidelity Ventilation Training Comparable to Real-Life Newborn Ventilation

Children ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. 940
Author(s):  
Joanna Haynes ◽  
Peder Bjorland ◽  
Øystein Gomo ◽  
Anastasia Ushakova ◽  
Siren Rettedal ◽  
...  
Keyword(s):  
Skill Acquisition ◽  
Low Cost ◽  
Negative Relationship ◽  
Real Life ◽  
Neonatal Resuscitation ◽  
Healthcare Personnel ◽  
Positive Pressure ◽  
High Fidelity ◽  
High Resource ◽  
Clinical Conditions

Face mask ventilation of apnoeic neonates is an essential skill. However, many non-paediatric healthcare personnel (HCP) in high-resource childbirth facilities receive little hands-on real-life practice. Simulation training aims to bridge this gap by enabling skill acquisition and maintenance. Success may rely on how closely a simulator mimics the clinical conditions faced by HCPs during neonatal resuscitation. Using a novel, low-cost, high-fidelity simulator designed to train newborn ventilation skills, we compared objective measures of ventilation derived from the new manikin and from real newborns, both ventilated by the same group of experienced paediatricians. Simulated and clinical ventilation sequences were paired according to similar duration of ventilation required to achieve success. We found consistencies between manikin and neonatal positive pressure ventilation (PPV) in generated peak inflating pressure (PIP), mask leak and comparable expired tidal volume (eVT), but positive end-expiratory pressure (PEEP) was lower in manikin ventilation. Correlations between PIP, eVT and leak followed a consistent pattern for manikin and neonatal PPV, with a negative relationship between eVT and leak being the only significant correlation. Airway obstruction occurred with the same frequency in the manikin and newborns. These findings support the fidelity of the manikin in simulating clinical conditions encountered during real newborn ventilation. Two limitations of the simulator provide focus for further improvements.

scholarly journals Unmet goals of neonatal nursing - an observational study

2020 ◽  
Vol 7 (9) ◽  
pp. 1901
Author(s):  
Saikiran Deshabhotla ◽  
Sonnathi Sandeep ◽  
Baswaraj Tandur
Keyword(s):  
Intensive Care ◽  
Urban Areas ◽  
Neonatal Intensive Care ◽  
Clinical Skills ◽  
Neonatal Resuscitation ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Emergency Situations ◽  
Neonatal Nursing ◽  
Level 2

Background: Neonatal nurses are the backbone of any neonatal service, spending maximum time in the care of the sick New-borns in the Neonatal intensive care unit (NICU). Objective of the study was to know about the educational qualification and assess the self-reported confidence in various clinical skills among the nurses working in level 2 & 3 NICUs, preferred learning methodology and assess self-reported stressors among the nurses working in level 2 and level 3 NICUsMethods: This cross-sectional study was done across Level II and Level III Neonatal intensive care units in urban areas of the city of Hyderabad, India over one year from January 2019 to December 2019. Individual questionnaires were distributed to each registered nurse working in the NICU for a minimum duration of six months who were willing to participate.Results: A total of 217 respondents were enrolled. The majority of the nurses were having General Nursing and Midwifery (GNM) qualification 52% (n=112). Nearly 26% (n=58) of the nurses were not comfortable performing bag and mask ventilation. Learning from senior nurses/colleagues as the most preferred mode of learning 45% (n=98). Low salaries 45% (n=98) followed by absence of doctors in emergency situations 37% (n=81) and high documentation (paperwork) 36% (n=78) were most frequently reported stressors.Conclusions: Most of the nursing participants qualified as GNM. Lacking skills of neonatal resuscitation. Mentor based learning needs to be facilitated by raising a cadre of neonatal nursing tutors in various nursing colleges. Paperless monitoring systems and other automation methods should be developed to reduce the documentation work of the staff. 

scholarly journals A Neonatal Intensive Care Unit’s Experience with Implementing an In-Situ Simulation and Debriefing Patient Safety Program in the Setting of a Quality Improvement Collaborative

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 202
Author(s):  
Mary Eckels ◽  
Terry Zeilinger ◽  
Henry C. Lee ◽  
Janine Bergin ◽  
Louis P. Halamek ◽  
...  
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Quality Improvement ◽  
Neonatal Intensive Care ◽  
Quality Care ◽  
Neonatal Resuscitation ◽  
Healthcare Team ◽  
In Situ Simulation ◽  
Implementation Phase

Extensive neonatal resuscitation is a high acuity, low-frequency event accounting for approximately 1% of births. Neonatal resuscitation requires an interprofessional healthcare team to communicate and carry out tasks efficiently and effectively in a high adrenaline state. Implementing a neonatal patient safety simulation and debriefing program can help teams improve the behavioral, cognitive, and technical skills necessary to reduce morbidity and mortality. In Simulating Success, a 15-month quality improvement (QI) project, the Center for Advanced Pediatric and Perinatal Education (CAPE) and California Perinatal Quality Care Collaborative (CPQCC) provided outreach and training on neonatal simulation and debriefing fundamentals to individual teams, including community hospital settings, and assisted in implementing a sustainable program at each site. The primary Aim was to conduct two simulations a month, with a goal of 80% neonatal intensive care unit (NICU) staff participation in two simulations during the implementation phase. While the primary Aim was not achieved, in-situ simulations led to the identification of latent safety threats and improvement in system processes. This paper describes one unit’s QI collaborative experience implementing an in-situ neonatal simulation and debriefing program.

Emotions and Experience of Fathers applying Kangaroo Care in the Eastern Anatolia Region of Turkey: A Qualitative Study

2020 ◽  
pp. 105477382093747
Author(s):  
Ulviye Günay ◽  
Didem Coşkun Şimşek
Keyword(s):  
Intensive Care Unit ◽  
Content Analysis ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
University Hospital ◽  
Eastern Anatolia ◽  
Kangaroo Care ◽  
Self Confidence ◽  
Parent Role ◽  
Qualitative Descriptive

The aim of this study was to investigate the emotions and experiences of fathers in Eastern Anatolia Region of Turkey who applied kangaroo care in the neonatal intensive care unit. This study applied the qualitative descriptive design. The study included 12 fathers at the NICU of a university hospital. The fathers practiced kangaroo care with their babies two times a day for 15 days. Content analysis was then conducted to determine the main themes and sub-themes of the interviews. Three main themes and six sub-themes emerged from the analysis: (1) Emotions of being a father (feeling that the baby belongs to own and feeling the warmth and scent of the baby); (2) Confidence in fathering roles (self-confidence and caring for the baby); and (3) Happiness in the new parent role (seeing the baby calm down, hugging the baby and touching the baby’s skin).

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