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Newborn Resuscitation: Advances in Training and Practice: 2nd Edition

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A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Neonatology".

Deadline for manuscript submissions: closed (1 December 2023) | Viewed by 17375

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Prof. Dr. Hege L. Ersdal

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Guest Editor

1. Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway
2. Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, 4011 Stavanger, Norway
Interests: newborn resuscitation; simulation-based education and translation to clinical practice; global health challenges on the day-of-birth
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Dear Colleagues,

The day of birth carries the highest risk of death during the whole lifetime of a person. Each year, an estimated 1 million newborns die on their first and only day of life. Another 1 million survive with lifelong neurodevelopmental impairment. The majority of these babies could have been saved with appropriate basic newborn resuscitation. About 10% of newborns need urgent and qualified help at birth, but the lifesaving procedure of newborn resuscitation is difficult to master and is reported to be inadequately performed around the world. Furthermore, the most effective ventilation modes and techniques remain to be established.

Evidence suggests that the implementation of newborn resuscitation training programs improves provider competences and newborn outcomes. However, the optimal time interval between training, and the issue of how teamwork and individual practical skills can be taught and learned, remain unclear. Multi-modal approaches including simulation-based training with emphasis on feedback/debriefing are thought to be the most beneficial modes of learning, and we need more knowledge on efficient strategies of increasing the implementation of such training in busy healthcare services, their transferability to clinical practices, and their impacts on newborn survival rates in different settings.

This Special Issue welcomes submissions which explore advances in newborn resuscitation training, clinical practice, and potential impacts in both high- and low-resource settings.

Prof. Dr. Hege L. Ersdal
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

newborn resuscitation
newborn heart rate
ventilation techniques
newborn outcome and development
novel training strategies
simulation-based training
implementation of training
training frequency and retention of skills
translation to clinical practice
clinical debriefing

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Published Papers (9 papers)

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12 pages, 1089 KiB

Open AccessArticle

The Effects of a Digital Game Simulator versus a Traditional Intervention on Paramedics’ Neonatal Resuscitation Performance

by Maria Cutumisu and Georg M. Schmölzer

Children 2024, 11(2), 174; https://doi.org/10.3390/children11020174 - 30 Jan 2024

Cited by 1 | Viewed by 1136

Abstract

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. Full article

(This article belongs to the Special Issue Newborn Resuscitation: Advances in Training and Practice: 2nd Edition)

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13 pages, 630 KiB

Open AccessArticle

Video-Recorded Airway Suctioning of Clear and Meconium-Stained Amniotic Fluid and Associated Short-Term Outcomes in Moderately and Severely Depressed Preterm and Term Infants

by Gazmend Berisha, Line Norman Kvenshagen, Anne Marthe Boldingh, Britt Nakstad, Elin Blakstad, Arild Erland Rønnestad and Anne Lee Solevåg

Children 2024, 11(1), 16; https://doi.org/10.3390/children11010016 - 22 Dec 2023

Viewed by 1514

Abstract

Background: The aim of this study was to investigate delivery room airway suctioning and associated short-term outcomes in depressed infants. Methods: This is a single-centre prospective observational study of transcribed video recordings of preterm (gestational age, GA < 37 weeks) and term (GA ≥ 37 weeks) infants with a 5 min Apgar score ≤ 7. We analysed the association between airway suctioning, breathing, bradycardia and prolonged resuscitation (≥10 min). For comparison, non-suctioned infants with a 5 min Apgar score ≤ 7 were included. Results: Two hundred suction episodes were performed in 19 premature and 56 term infants. Breathing improved in 1.9% of premature and 72.1% of term infants, and remained unchanged in 84.9% of premature and 27.9% of term infants after suctioning. In our study, 61 (81.3%) preterm and term infants who were admitted to the neonatal intensive care unit experienced bradycardia after airway suctioning. However, the majority of the preterm and more than half of the term infants were bradycardic before the suction procedure was attempted. Among the non-airway suctioned infants (n = 26), 73.1% experienced bradycardia, with 17 non-airway suctioned infants being admitted to the neonatal intensive care unit. There was a need for resuscitation ≥ 10 min in 8 (42.1%) preterm and 32 (57.1%) term infants who underwent airway suctioning, compared to 2 (33.3%) preterm and 19 (95.0%) term infants who did not receive airway suctioning. Conclusions: In the infants that underwent suctioning, breathing improved in most term, but not preterm infants. More non-suctioned term infants needed prolonged resuscitation. Airway suctioning was not directly associated with worsening of breathing, bradycardia, or extended resuscitation needs. Full article

(This article belongs to the Special Issue Newborn Resuscitation: Advances in Training and Practice: 2nd Edition)

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11 pages, 501 KiB

Open AccessArticle

Impact of an Educational Clinical Video Combined with Standard Helping Babies Breathe Training on Acquisition and Retention of Knowledge and Skills among Ethiopian Midwives

by Amara J. Heard Stittum, Erika M. Edwards, Mahlet Abayneh, Asrat Demtse Gebremedhin, Delia Horn, Sara K. Berkelhamer and Danielle E. Y. Ehret

Children 2023, 10(11), 1782; https://doi.org/10.3390/children10111782 - 4 Nov 2023

Viewed by 1230

Abstract

Helping Babies Breathe (HBB) is an evidence-based neonatal resuscitation program designed for implementation in low-resource settings. While HBB reduces rates of early neonatal mortality and stillbirth, maintenance of knowledge and skills remains a challenge. The extent to which the inclusion of educational clinical videos impacts learners’ knowledge and skills acquisition, and retention is largely unknown. We conducted a cluster-randomized controlled trial at two public teaching hospitals in Addis Ababa, Ethiopia. We randomized small training group clusters of 84 midwives to standard HBB vs. standard HBB training supplemented with exposure to an educational clinical video on newborn resuscitation. Midwives were followed over a 7-month time period and assessed on their knowledge and skills using standard HBB tools. When comparing the intervention to the control group, there was no difference in outcomes across all assessments, indicating that the addition of the video did not influence skill retention. Pass rates for both the control and intervention group on bag and mask skills remained low at 7 months despite frequent assessments. There is more to learn about the use of educational videos along with low-dose, high-frequency training and how it relates to retention of knowledge and skills in learners. Full article

(This article belongs to the Special Issue Newborn Resuscitation: Advances in Training and Practice: 2nd Edition)

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13 pages, 2382 KiB

Open AccessArticle

A Simulation Competition on Neonatal Resuscitation as a New Educational Tool for Pediatric Residents

by Lorenzo Zanetto, Francesco Cavallin, Nicoletta Doglioni, Benedetta Bua, Sandro Savino, Giuseppe De Bernardo, Simone Pratesi, Paolo Ernesto Villani, Gary M. Weiner, Daniele Trevisanuto and on behalf of the Task Force on Neonatal Resuscitation of the Italian Society of Neonatology

Children 2023, 10(10), 1621; https://doi.org/10.3390/children10101621 - 28 Sep 2023

Cited by 1 | Viewed by 1294

Abstract

Background: Training programs on resuscitation have been developed using simulation-based learning to build skills, strengthen cognitive strategies, and improve team performance. This is especially important for residency programs where reduced working hours and high numbers of residents can reduce the educational opportunities during the residency, with lower exposure to practical procedures and prolonged length of training. Within this context, gamification has gained popularity in teaching and learning activities. This report describes the implementation of a competition format in the context of newborn resuscitation and participants’ perceptions of the educational experience. Methods: Thirty-one teams of three Italian pediatric residents participated in a 3-day simulation competition on neonatal resuscitation. The event included an introductory lecture, familiarization time, and competition time in a tournament-like structure using high-fidelity simulation stations. Each match was evaluated by experts in neonatal resuscitation and followed by a debriefing. The scenarios and debriefings of simulation station #1 were live broadcasted in the central auditorium where teams not currently competing could observe. At the end of the event, participants received an online survey regarding their perceptions of the educational experience. Results: 81/93 (87%) participants completed the survey. Training before the event mostly included reviewing protocols and textbooks. Low-fidelity manikins were the most available simulation tools at the residency programs. Overall, the participants were satisfied with the event and appreciated the live broadcast of scenarios and debriefings in the auditorium. Most participants felt that the event improved their knowledge and self-confidence and stimulated them to be more involved in high-fidelity simulations. Suggested areas of improvement included more time for familiarization and improved communication between judges and participants during the debriefing. Conclusions: Participants appreciated the simulation competition. They self-perceived the educational impact of the event and felt that it improved their knowledge and self-confidence. Our findings suggest areas of improvements for further editions and may serve as an educational model for other institutions. Full article

(This article belongs to the Special Issue Newborn Resuscitation: Advances in Training and Practice: 2nd Edition)

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15 pages, 2766 KiB

Open AccessArticle

NeoCheck: A New Checklist to Assess Performance during Newborn Life Support—A Validation Study

by Katharina Bibl, Felix Eibensteiner, Valentin Ritschl, Philipp Steinbauer, Angelika Berger, Monika Olischar, Vito Giordano and Michael Wagner

Children 2023, 10(6), 1013; https://doi.org/10.3390/children10061013 - 4 Jun 2023

Cited by 1 | Viewed by 2626

Abstract

Background: The aim of this study was to design and validate a new checklist and standardized scenario for assessing providers’ performance during Newborn Life Support (NLS). Methods: We invited twelve experts in Neonatology to take part in a three-step Delphi process. They rated the importance of each item of a newly designed assessment tool to evaluate participants’ performance during Newborn Life Support independently on a numeric rating scale from 1 to 5 (1 = lowest; 5 = highest) and were able to give additional comments. All items achieving a mean rating below four after the third round were deleted. For the reliability of the checklist, we calculated interrater reliability. Results: Using a standardized Delphi process, we revised the initial checklist according to the experts’ ratings and comments. The final assessment tool includes 38 items covering all relevant steps during NLS. The mean expert rating of all items was 4.40. Interrater reliability showed substantial agreement between the two raters in the first draft (κ = 0.80) as well as in the final draft of the checklist (κ = 0.73). Conclusion: We designed a feasible assessment tool for evaluating performance during NLS. We proved the checklist to be valid and reasonable using a Delphi validation process and calculating interrater reliability. Full article

(This article belongs to the Special Issue Newborn Resuscitation: Advances in Training and Practice: 2nd Edition)

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10 pages, 1652 KiB

Open AccessArticle

Fetal to Neonatal Heart Rate Transition during Normal Vaginal Deliveries: A Prospective Observational Study

by Yuda Munyaw, Jarle Urdal, Hege Ersdal, Matilda Ngarina, Robert Moshiro, Ladislaus Blacy and Jorgen E. Linde

Children 2023, 10(4), 684; https://doi.org/10.3390/children10040684 - 4 Apr 2023

Cited by 2 | Viewed by 2662

Abstract

Documentation of fetal to neonatal heart rate (HR) transition is limited. The aim of the current study was to describe HR changes from one hour before to one hour after normal vaginal deliveries. We conducted a prospective observational cohort study in Tanzania from 1 October 2020 to 30 August 2021, including normal vaginal deliveries with normal neonatal outcomes. HR was continuously recorded from one hour before to one hour after delivery, using the Moyo fetal HR meter, NeoBeat newborn HR meter, and the Liveborn Application for data storage. The median, 25th, and 75th HR percentiles were constructed. Overall, 305 deliveries were included. Median (interquartile range; IQR) gestational age was 39 (38–40) weeks and birthweight was 3200 (3000–3500) grams. HR decreased slightly during the last 60 min before delivery from 136 (123,145) to 132 (112,143) beats/minute. After delivery, HR increased within one minute to 168 (143,183) beats/min, before decreasing to around 136 (127,149) beats/min at 60 min after delivery. The drop in HR in the last hour of delivery reflects strong contractions and pushing. The rapid increase in initial neonatal HR reflects an effort to establish spontaneous breathing. Full article

(This article belongs to the Special Issue Newborn Resuscitation: Advances in Training and Practice: 2nd Edition)

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13 pages, 1267 KiB

Open AccessArticle

Delayed and Interrupted Ventilation with Excess Suctioning after Helping Babies Breathe with Congolese Birth Attendants

by Jackie K. Patterson, Daniel Ishoso, Joar Eilevstjønn, Melissa Bauserman, Ingunn Haug, Pooja Iyer, Beena D. Kamath-Rayne, Adrien Lokangaka, Casey Lowman, Eric Mafuta, Helge Myklebust, Tracy Nolen, Janna Patterson, Antoinette Tshefu, Carl Bose and Sara Berkelhamer

Children 2023, 10(4), 652; https://doi.org/10.3390/children10040652 - 30 Mar 2023

Cited by 4 | Viewed by 1864

Abstract

There is a substantial gap in our understanding of resuscitation practices following Helping Babies Breathe (HBB) training. We sought to address this gap through an analysis of observed resuscitations following HBB 2nd edition training in the Democratic Republic of the Congo. This is a secondary analysis of a clinical trial evaluating the effect of resuscitation training and electronic heart rate monitoring on stillbirths. We included in-born, liveborn neonates ≥28 weeks gestation whose resuscitation care was directly observed and documented. For the 2592 births observed, providers dried/stimulated before suctioning in 97% of cases and suctioned before ventilating in 100%. Only 19.7% of newborns not breathing well by 60 s (s) after birth ever received ventilation. Providers initiated ventilation at a median 347 s (>five minutes) after birth; no cases were initiated within the Golden Minute. During 81 resuscitations involving ventilation, stimulation and suction both delayed and interrupted ventilation with a median 132 s spent drying/stimulating and 98 s suctioning. This study demonstrates that HBB-trained providers followed the correct order of resuscitation steps. Providers frequently failed to initiate ventilation. When ventilation was initiated, it was delayed and interrupted by stimulation and suctioning. Innovative strategies targeting early and continuous ventilation are needed to maximize the impact of HBB. Full article

(This article belongs to the Special Issue Newborn Resuscitation: Advances in Training and Practice: 2nd Edition)

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18 pages, 9713 KiB

Open AccessArticle

“Safer Births Bundle of Care” Implementation and Perinatal Impact at 30 Hospitals in Tanzania—Halfway Evaluation

by Hege Ersdal, Paschal Mdoe, Estomih Mduma, Robert Moshiro, Godfrey Guga, Jan Terje Kvaløy, Felix Bundala, Boniphace Marwa and Benjamin Kamala

Children 2023, 10(2), 255; https://doi.org/10.3390/children10020255 - 30 Jan 2023

Cited by 4 | Viewed by 2603

Abstract

Safer Births Bundle of Care (SBBC) consists of innovative clinical and training tools for improved labour care and newborn resuscitation, integrated with new strategies for continuous quality improvement. After implementation, we hypothesised a reduction in 24-h newborn deaths, fresh stillbirths, and maternal deaths by 50%, 20%, and 10%, respectively. This is a 3-year stepped-wedged cluster randomised implementation study, including 30 facilities within five regions in Tanzania. Data collectors at each facility enter labour and newborn care indicators, patient characteristics and outcomes. This halfway evaluation reports data from March 2021 through July 2022. In total, 138,357 deliveries were recorded; 67,690 pre- and 70,667 post-implementations of SBBC. There were steady trends of increased 24-h newborn and maternal survival in four regions after SBBC initiation. In the first region, with 13 months of implementation (n = 15,658 deliveries), an estimated additional 100 newborns and 20 women were saved. Reported fresh stillbirths seemed to fluctuate across time, and increased in three regions after the start of SBBC. Uptake of the bundle varied between regions. This SBBC halfway evaluation indicates steady reductions in 24-h newborn and maternal mortality, in line with our hypotheses, in four of five regions. Enhanced focus on uptake of the bundle and the quality improvement component is necessary to fully reach the SBBC impact potential as we move forward. Full article

(This article belongs to the Special Issue Newborn Resuscitation: Advances in Training and Practice: 2nd Edition)

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10 pages, 2779 KiB

Open AccessPerspective

Capacity Building in Remote Facilitation of Newborn Resuscitation

by Emily Ahn, Beena D. Kamath-Rayne, Jeffrey Perlman and Sara Berkelhamer

Children 2023, 10(6), 1038; https://doi.org/10.3390/children10061038 - 9 Jun 2023

Cited by 2 | Viewed by 1439

Abstract

The past decade has been notable for widespread dissemination of newborn resuscitation training in low-resource settings through simplified training programs including Helping Babies Breathe. Since 2020, implementation efforts have been impacted by restrictions on travel and in-person gatherings with the SARS-CoV-2 pandemic, prompting the development of alternative methods of training. While previous studies have demonstrated feasibility of remote neonatal resuscitation training, this perspective paper covers common barriers identified and key lessons learned developing a cadre of remote facilitators. Challenges of remote facilitation include mastering videoconferencing platforms, establishing personal connections, and providing effective oversight of skills practice. Training sessions can be used to support facilitators in acquiring comfort and competency in harnessing videoconferencing platforms for effective facilitation. Optimization of approaches and investment in capacity building of remote facilitators are imperative for effective implementation of remote neonatal resuscitation training. Full article

(This article belongs to the Special Issue Newborn Resuscitation: Advances in Training and Practice: 2nd Edition)

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