Evaluation of neonatal resuscitation simulation exercise for perinatal medical personnel / 中国新生儿科杂志

Objective:To evaluate the efficacy of neonatal resuscitation simulation exercise for perinatal medical personnel.Methods:From August 2020 to July 2021, perinatal medical personnel receiving simulated training of neonatal resuscitation in our hospital were prospectively enrolled. The professional backgrounds of the trainees were collected and their performances on both knowledge skills and behavioral skills were scored. The knowledge skills included pre-resuscitation preparation, initial resuscitation, positive pressure ventilation, tracheal intubation, chest compression and umbilical vein catheterization. The behavioral skills included situational awareness, problem solving, resource utilization, communication and leadership. SPSS 26.0 was used for data analysis.Results:Among the 200 participants, 127(63.5%) were neonatal/pediatric doctors and nurses, 65(32.5%) were obstetricians and midwives, 8(4.0%) were anesthesiologists and the ratio of doctors to nurses was 1.74∶1. The score of knowledge skills was (19.52±2.92) at the beginning of the simulation exercise and (27.02±2.72) at the end. The scores on preparation before resuscitation, initial resuscitation and positive pressure ventilation were significantly improved ( P<0.05). The score of behavioral skills was (16.60±2.34) at the beginning and (20.58±1.77) at the end. The scores of resource utilization, communication and leadership were significantly improved ( P<0.05). Conclusions:The simulation exercise provides multidisciplinary teamwork training for perinatal medical personnel, may significantly improve neonatal resuscitation skills and is worth promoting.

Application of PDCA cycle in quality improvement of neonatal resuscitation / 中国新生儿科杂志

Objective:To study the effects of plan-do-check-action (PDCA) cycle in quality improvement of neonatal resuscitation.Methods:From 2016 to 2020, the clinical data of neonates born in our hospital were analyzed. Neonates born during 2016 to 2017 were pre-PDCA group and neonates born during 2018 to 2020 were post-PDCA group. PDCA quality improvement included step-by-step, high-frequency and low-dose training, strengthening teamwork and adding equipment.Results:A total of 7 728 live-birth neonates were delivered before PDCA with 319 cases (4.1%) of asphyxia. 10 174 live-birth neonates were delivered after PDCA with 422 cases (4.1%) of asphyxia. The asphyxia rates showed no significant difference between the two groups ( P>0.05). The incidences of severe asphyxia before and after PDCA were both 0.8% without significant difference ( P>0.05). The success rates of resuscitation for severe asphyxia before and after PDCA was 27.9% and 44.9%, respectively, and the differences were statistically significant ( P<0.05). The mortality rates within 7 d before and after PDCA were 0.5‰ and 0.1‰ respectively, without significant differences ( P>0.05). Conclusions:The implementation of PDCA cycle and step-by-step, high-frequency, low-dose neonatal resuscitation training can effectively improve the success rate of resuscitation in newborns with severe asphyxia.

Clinical value of neonatal transport team participating in the management of twin neonates before transport / 中国小儿急救医学

Objective:To investigate and analyze the necessity and clinical significance of professional neonatal transport team participating in post-natal resuscitation, management and transport of twin neonates after birth.Methods:A total of 298 cases of twin neonates admitted to the Department of Neonatology at the Fifth Medical Center of PLA General Hospital from January 2017 to December 2021 were selected.According to whether the neonatal transport team participated in birth resuscitation and management, they were divided into participation group ( n=136) and case group ( n=162). The resuscitation measures taken after birth, Apgar score, respiratory support during transport, basic information at admission, the first arterial blood gas after admission, complications during hospitalization, length of stay and outcome of the two groups of twins were retrospectively analyzed. Results:Compared with twins in case group, the proportion of tracheal intubation before transport was significantly higher in participation group(5.88% vs.0.62%, χ2=6.997, P=0.013), hospital admissions were significantly shorter[48(7, 115) min vs.87(47, 425) min, Z=-11.593, P<0.001], and significantly lower rates of hypoxia on admission(9.56% vs.17.90%, χ2=4.250, P=0.039), significantly higher percutaneous oxygen saturation[96(86, 100)% vs.95(85, 100)%, Z=-7.274, P<0.001], and higher blood-gas-oxygen partial pressure on admission[(91.02±25.77)mmHg vs.(87.82±25.23)mmHg, t=1.076, P=0.008] were found.The incidence of hypothermia on admission was significantly lower(36.03% vs.47.53%, χ2=4.008, P=0.045), and the differences between two groups were statistically significant( P<0.05). The proportion of critically ill neonates(40.44% vs.24.07%, χ2=9.172, P=0.002), length of hospital-stay[11(4, 76)d vs.9(3, 72) d, Z=-2.684, P=0.014] as well as the intravenous nutrition time[7(0, 42)d vs.5(0, 40) d, Z=-2.470, P=0.014] in participaton group were significantly higher than those in case group, and there were statistically significant differences between two groups( P<0.05). Conclusion:Professional neonatal transport teams play a positive role in neonatal resuscitation and later hospitalization during the pre-transport management of twin neonates.It can improve success rate of tracheal intubation in asphyxia resuscitation of twin neonates.Neonatal transport to the NICU for management takes less time, reducing the incidence of hypoxemia during transport, hypoxia status and hypothermia after admission.Obstetric pediatric medical staff in midwifery hospitals should strengthen the professional training of neonatal asphyxiation resuscitation, improve the skill of neonatal asphyxiation resuscitation and tracheal intubation, and strengthen the post-birth care for twin neonates.

Reanimación neonatal en sala de partos en Villa Clara / Neonatal resuscitation in the delivery room in Villa Clara province

Introducción: La pérdida de bienestar fetal perinatal es la situación que con mayor frecuencia condiciona la necesidad de reanimación cardiopulmonar del recién nacido en el momento del parto. Objetivo: Describir las características clínicas y epidemiológicas de los neonatos reanimados en la sala de partos. Métodos: Se realizó una investigación de desarrollo, descriptivo, observacional, retrospectivo, en el Hospital Provincial Universitario Ginecoobstétrico Mariana Grajales de Santa Clara desde enero de 2017 a diciembre de 2021. La muestra coincidió con el universo y estuvo compuesta por 106 neonatos que obtuvieron una puntuación de Apgar bajo (inferior a siete), evaluado al primer minuto después del nacimiento que requirieron alguna maniobra de reanimación neonatal en la sala de partos. Se empleó cálculo de frecuencias absoluta y relativa, además de contraste de proporciones mediante Chi-Cuadrado para las variables cualitativas como resultado de esta prueba. Resultados: Fueron más frecuentes los recién nacidos con peso normal (75,5 por ciento), al término de la gestación (65,1 por ciento) y del sexo masculino (61,3 por ciento). La cesárea como vía final del parto (51,9 por ciento) y la presencia de líquido amniótico meconial; fueron variables con mayor porcentaje dentro de las variables perinatales seleccionadas. El 8,5 por ciento de los neonatos reanimados fallecieron. Conclusiones: Las variables clínicas y epidemiológicas más frecuentes en el estudio coincidieron con la literatura consultada. La mayoría de los neonatos reanimados sobrevivieron(AU)

Introduction: Perinatal loss of fetal well-being is the situation that most frequently creates the need for newborn cardiopulmonary resuscitation at delivery. Objective: To describe the clinical and epidemiological characteristics of neonates resuscitated in the delivery room. Methods: A developmental, descriptive, observational, retrospective and descriptive research was carried out at Mariana Grajales Gynecobstetric University Provincial Hospital, of Santa Clara (Villa Clara Province, Cuba), from January 2017 to December 2021. The sample coincided with the universe and was made up of 106 neonates with low Apgar score (lower than seven), evaluated at the first minute after birth, who required some neonatal resuscitation maneuver in the delivery room. Calculation of absolute and relative frequencies was used, as well as contrast of proportions by chi-square for qualitative variables resulting from this test. Results: Newborns with normal weight (75.5 percent), at term (65.1 percent) and male (61.3 percent) were more frequent. Cesarean section as the final route of delivery (51.9 percent) and the presence of meconium amniotic fluid were the variables with the highest percentage from among the selected perinatal variables. 8.5 percent of the resuscitated neonates died. Conclusions: The most frequent clinical and epidemiological variables in the study coincided with the consulted literature. Most of the resuscitated neonates survived(AU)

Effectiveness of Neonatal Resuscitation program training among MBBS interns in a Tertiary care hospital of South India

Background: Use of simulation-based learning methodologies enhance performance in both simulated resuscitations and real-life clinical situations. Retention of skill is very important for the MBBS doctors who hardly get any exposure to such learning before entering post-graduate courses. The major cause of early neonatal death is neonatal asphyxia, which can be prevented by neonatal resuscitation. Effective resuscitation at birth can prevent neonatal deaths to a greater extent. Training in cardio-pulmonary resuscitation is critical in determining successful outcomes in perinatal asphyxia. Hence the present study was done to check the retention of knowledge after Neonatal Resuscitation Program (NRP ) training. Methods: A prospective interventional study was carried out among the MBBS interns who started their internship program from March 2020 - February 2021 in ACSR Government Medical College, Nellore. All the Interns were given training in NRP as a part of internship orientation programme during the first week of internship. Out of 150 interns, 143 participated in the study. The interns were oriented to the study and a pretest questionnaire was administered to them to assess their knowledge and skill regarding NRP which was followed by NRP training by the faculty of pediatrics and neonatology. The same questionnaire was administered immediately at the end of the training, 1 and 6 months post NRP training for assessing their knowledge and skill. Results: As compared to pre intervention score, the mean scores of the immediate post intervention score and at 1 month after intervention the mean score was increased with respect to knowledge and skills. After 6 months the mean scores pertaining to knowledge and skill decreased which were statistically significant. Conclusions: A significant decrease in the level of knowledge and skills regarding neonatal resuscitation was observed. Therefore, maintaining resuscitation skill requires continuous practice, supplemented by simulation training as needed.

Problems and thoughts in the application of neonatal resuscitation technology in rural primary hospitals / 中国实用护理杂志

Neonatal resuscitation project to rural grass-roots development is different from urban promotion and application, need to adjust appropriate strategies and measures. Correct understanding of the effectiveness of resuscitation technology can improve the compliance of rural grass-roots promotion and application. According to "Renewal of International Neonatal Resuscitation Course and China′s Implementation Opinions", we should make the training of recovery teams as an important goal of long-term management, And adhere to "one case one preparation, one monitoring, one week one review". Rural grass-roots units should innovate and popularize application methods according to local conditions. It is suggested that the training system for neonatal resuscitation and post-resuscitation treatment should be gradually established in county (city) areas.

Effect of single low dose intrathecal labor analgesia on maternal and fetal outcome

Background: Labour is one of the most painful experiences women encounter during their lifetime and the experience is different for each women. Aim of the study was to evaluate the effect of low dose intrathecal labour analgesia using fentanyl, bupivacaine and morphine on maternal and fetal outcome.Methods: 100 parturients with uncomplicated pregnancy in spontaneous or induced labor at cervical dilatation 4-6cm were enrolled for the study. They were randomized into two groups of 50 each, using computer based block randomization. Group 1 (N=50) received intrathecal labor analgesia using. Fentanyl (25µg), bupivacaine (2.5mg) and morphine (250µg) and Group 2 (N=50) received programmed labor. The two groups were well matched in terms of age, weight, height, parity, baseline vitals and mean cervical dilatation at the time of administration of labor analgesia . Progress of labor, duration of analgesia, and neonatal APGAR score were recorded. Feto-maternal and neonatal outcomes were studied and compared between the two groups.Results: The mean duration of analgesia in group1 was 238.96±21.888 min whereas the mean duration of analgesia in group 2 was 98.4±23.505 min. The difference was significant P value 0.00. One out of 50 (2%) of the parturients required rescue analgesia in Group 1. On the contrary all 44 parturients in Group 2 required rescue analgesia. Difference was significant (p value=0.00) However duration of the stages of labor, operative and instrumental deliveries and APGAR score did not differ in the two groups.Conclusions: Single shot intrathecal labor analgesia is a safe, effective, reliable, cheap and satisfactory method of pain relief for labor and delivery. Moreover, it is devoid of major side effects.

Pregnancy outcomes of normal versus abnormal cardiotocography in a tertiary centre in Nepal

Background: Pregnancy and childbirth is normal physiological process with great pathological potential. The obstetricians are more concerned with the early recognition of fetal distress during labour and such an adverse outcome should be detected at the earliest point of time by an effective surveillance method. Cardiotocography as a part of biophysical profile has become an established diagnostic tool for fetal surveillance. To compare early perinatal outcome of normal and abnormal cardiotocography in terms of APGAR scores, need for neonatal resuscitation, NICU admission, perinatal death and mode of delivery.Methods: It was a cross-sectional study. 200 nulliparous/multiparous women with singleton pregnancy in cephalic presentation at gestational age 37-42 weeks in latent stage of labor were enrolled in the study and subjected to admission test in left lateral position using fetal monitor. Baseline FHR and contraction pattern were determined for 20 minutes and classification of patients was done into normal, and suspicious or abnormal according to the FIGO guidelines 2015.Results: Low APGAR scores, rate of LSCS, need for neonatal resuscitation, neonatal admission were more in the abnormal cardiotocography group. Cardiotocography in the current study has high sensitivity and high negative predictive value for detecting fetal distress.Conclusions: From the analysis of this study, it would be safe to conclude that an ominous cardiotocography should be managed appropriately without delay and obstetrician should be vigilant in suspicious as well as in normal admission test group for timely intervention for bettering the neonatal outcome.

Coexisting Congenital Subglosso-palatal Membrane and Tongue Dermoid in a Neonate

Background: Neonatal respiratory distress due to coexisting subglosso-palatalmembrane and tongue dermoid has not been reported yet. Case characteristics: Anewborn with respiratory distress having a membrane in the oral cavity. Excision ofmembrane revealed a tongue mass with cleft palate, obstructing the nasopharynxcompletely. Elective ventilation was followed by excision of mass. Outcome: The childwas cured with uneventful course at follow-up of six months. Message: Co-existingcongenital anomalies causing airway obstruction may be missed in presence ofsubglosso-palatal membrane.

Feasibility of Oxygen Saturation Monitoring During Neonatal Resuscitation in Indian Scenario

This observational study assessed the feasibility of using pulseoximeter during neonatal resuscitation in 428 term and preterm(32-36 weeks) neonates. The oxygen saturation reading wasobtained by 1-minute in 152 (35.5%) neonates. Preterm neonatesand babies born by LSCS took relatively longer time for firstdetection of saturation.

Simulation-based medical education and its implementation in neonatal asphyxia resuscitation training / 中华医学教育探索杂志

Simulation-based medical education is a new teaching method using modern intelligent science and technology to carry out clinical practice training,This article analyzes the current situation of simulation teaching training in neonatal asphyxia resuscitation and discusses its advantages,namely highly simulated and repetitive teaching scene,safe and reliable teaching process,potentially incentive teaching environment,flexible teaching content and cooperation of the teaching team.

Application of sustained lung inflations for neonatal resuscitation / 中华实用儿科临床杂志

Application of sustained lung inflation (SLI)during neonatal resuscitation can increase alveolar opening,promote lung fluid absorption and maintain the appropriate functional residual capacity (FRC) which can complete the transition from fetal phase of respiratory system to neonatal period.In recent years,SLI has also been confirmed by a large number of animal experiments and clinical studies,and it is expected to be practically applied in the resuscitation of newborns.However,more randomized controlled trials with a large number of samples is required for exploring suitable populations,methods of operation,and recent or long-term effects on newborns.Now,the application and research of SLI in neonatal resuscitation are described.

Singapore Neonatal Resuscitation Guidelines 2016

We present the revised Neonatal Resuscitation Guidelines for Singapore. The 2015 International Liaison Committee on Resuscitation Neonatal Task Force's consensus on science and treatment recommendations (2015), and guidelines from the American Heart Association and European Resuscitation Council were debated and discussed. The final recommendations of the National Resuscitation Council, Singapore, were derived after the task force had carefully reviewed the current available evidence in the literature and addressed their relevance to local clinical practice.

Actualización en reanimación neonatal / Update on neonatal resuscitation

Se presentan los cambios más importantes que se han hecho en el Programa de Reanimación Neonatal, los cuales están basados en 5 años de una revisión rigurosa y en la mejor evidencia. Han sido realizadas por el International Liaison Committee on Resuscitation y reflejado en su Consensus on Science and Treatment Recommendations(AU)

The most important changes in the Neonatal Resuscitation Program, which are based on 5 years of rigorous review and on best evidence, were presented. They have been made by the International Liaison Committee on Resuscitation and stated in its Consensus on Science and Treatment Recommendations(AU)

The course of development, present situation and policy trends of neonatal resuscitation program / 中国实用护理杂志

The neonatal resuscitation program consisted of three stages:pilot promotion, provinces promotion and grass-roots promotion in China. Neonatal resuscitation was easy to learn, training forms were various, the duration was different. There were regional differences in the pass rate of examination and standard recovery rate. The neonatal resuscitation training rate, the system execution rate and the equipment rate in primary hospitals was lower than secondary hospitals and tertiary hospitals. The primary hospitals would be the key link of the neonatal resuscitation program. We suggested to build neonatal resuscitation training and treatment system.

Application of case simulation and participatory feedback teaching in neonatal resuscitation training / 中华医学教育探索杂志

Objective To investigate the effect of case simulation and participatory feedback teaching used for neonatal resuscitation training. Methods One hundred and twenty medical staff was selected as subjects from Obstetric and Pediatric department and were randomized into 4 batches to receive a neonatal resuscitation training program that consisted of theoretical lectures and skill practice. In the control group (first two batches), the teacher demonstrated procedures of neonatal resuscitation, then trainees practiced alone and the teacher corrected their wrong procedure. In the observation group (last two batches), interactive teaching was employed and the training was performed into three steps:practice of skill in teams, watch the procedure of their practice, the feedback. The theoretical exami-nation score, practical examination score, teamwork ability and satisfaction were compared between two groups. SPSS 16.0 was employed for statistical analysis, with α=0.05 as detection level. Results The theoretical examination scores of control group and observation group were (34.27 ±2.26) vs. (33.68±2.32). There was no significant difference in theoretical examination score between the two groups ( P=0 . 166 ) . The practice examination score s of control group and observation group were (36.15±1.46) vs. (34.79±2.43), with significant differences (P=0.000). The teamwork ability of control group and observation group were (35.78 ±1.26) vs. (33.63 ±1.98), with obviously significant differ-ences (P=0.000). The trainees individual study interest, practice intent, knowledge and satisfaction with the training in the observation group were significantly higher than the control group. These results were (8.45±2.75) vs. (6.24±2.28), P=0.001;(8.25±2.05) vs. (6.48±2.75), P=0.003;(7.23±1.37) vs. (5.75 ±1.74), P=0.000; (8.21 ±1.45) vs. (6.34 ±1.69), P=0.000. Conclusion Application of the teaching in neonatal resuscitation training can enhance comprehensive practical skills and team coop-eration ability in med-ical staff, and it improves trainee's satisfaction with the training.

Evaluation of Algorithm-Based Simulation Scenario for Emergency Measures with High-Risk Newborns Presenting with Apnea

PURPOSE: This study was done to develop and evaluate an algorithm-based simulation scenario for emergency measures for high-risk newborns presenting with apnea. METHODS: A one shot case study design was used to evaluate the algorithm-based simulation scenario. Effects of the developed simulation scenario were evaluated using the Simulation Effectiveness Tool (SET) and the Lasater Clinical Judgement Rubric (LCJR). From March to November 137 senior nursing students completed the simulation using this scenario. RESULTS: The eight-frame simulation scenario was developed based on the Neonatal Resuscitation Program (NRP) and the nursing clinical judgment process. After use of the scenario, overall scores for SET and LCJR were 21.0 out of 26.0 and 32.4 out of 44.0 respectively. There were no significant differences in scores according to general characteristics. Positive correlation coefficients were identified among overall and subcategories of SET and LCJR. In addition, students provided positive feedback on the simulation experience. CONCLUSION: Considering that nursing students have limited access to high-risk newborns during their clinical experience and that newborns presenting apnea are common in the neonatal intensive care unit, the simulation scenario developed in this study is expected to provide nursing students with more opportunities to practice emergency measures for high-risk newborns.

Evaluation of Algorithm-Based Simulation Scenario for Emergency Measures with High-Risk Newborns Presenting with Apnea

PURPOSE: This study was done to develop and evaluate an algorithm-based simulation scenario for emergency measures for high-risk newborns presenting with apnea. METHODS: A one shot case study design was used to evaluate the algorithm-based simulation scenario. Effects of the developed simulation scenario were evaluated using the Simulation Effectiveness Tool (SET) and the Lasater Clinical Judgement Rubric (LCJR). From March to November 137 senior nursing students completed the simulation using this scenario. RESULTS: The eight-frame simulation scenario was developed based on the Neonatal Resuscitation Program (NRP) and the nursing clinical judgment process. After use of the scenario, overall scores for SET and LCJR were 21.0 out of 26.0 and 32.4 out of 44.0 respectively. There were no significant differences in scores according to general characteristics. Positive correlation coefficients were identified among overall and subcategories of SET and LCJR. In addition, students provided positive feedback on the simulation experience. CONCLUSION: Considering that nursing students have limited access to high-risk newborns during their clinical experience and that newborns presenting apnea are common in the neonatal intensive care unit, the simulation scenario developed in this study is expected to provide nursing students with more opportunities to practice emergency measures for high-risk newborns.

Knowledge and skills of neonatal resuscitation of health professionals at a university teaching hospital of Northwest Ethiopia / 世界急诊医学杂志（英文）

BACKGROUND: Competency in neonatal resuscitation is critical in the delivery rooms, neonatology units and pediatrics intensive care units to ensure the safety and health of neonates. Each year, millions of babies do not breathe immediately at birth, and among them the majority require basic neonatal resuscitation. Perinatal asphyxia is a major contributor to neonatal deaths worldwide in resource-limited settings. Neonatal resuscitation is effective only when health professionals have sufficient knowledge and skills. But malpractices by health professionals are frequent in the resuscitation of neonates. The present study was to assess the knowledge and skills of health professionals about neonatal resuscitation. METHODS: An institution based cross-sectional study was conducted in our hospital from February15 to April 30, 2014. All nurses, midwives and residents from obstetrics-gynecology (obs-gyn), midwifery and pediatric departments were included. The mean scores of knowledge and skills were compared for sex, age, type of profession, qualification, year of service and previous place of work of the participants by using Student'st test and ANOVA with Scheffe's test. AP value <0.05 was considered statistically significant. RESULTS: One hundred and thirty-five of 150 participants were included in this study with a response rate of 90.0％. The overall mean scores of knowledge and skills of midwives, nurses and residents were 19.9 (SD=3.1) and 6.8 (SD=3.9) respectively. The mean knowledge scores of midwives, nurses, pediatric residents and obs-gyn residents were 19.7 (SD=3.03), 20.2 (SD=2.94), 19.7 (SD=4.4) and 19.6 (SD=3.3) respectively. Whereas the mean scores of skills of midwives, nurses, pediatric residents and obs-gyn residents were 7.1 (SD=4.17), 6.7 (SD=3.75), 5.7 (SD=4.17) and 6.6 (SD=3.97) respectively. CONCLUSIONS: The knowledge and skills of midwives, nurses and residents about neonatal resuscitation were substandardized. Training of neonatal resuscitation for midwives, nurses and residents should be emphasized.