Who's teaching neonatal resuscitation to housestaff? Results of a national survey.

OBJECTIVE: This study was designed to investigate current patterns of training in neonatal resuscitation in US residency programs in general pediatrics. METHODS: A questionnaire was mailed to the chief residents and directors of all US residency programs in general pediatrics to determine who provides supervision and teaching of neonatal resuscitation in the delivery room and neonatal intensive care unit. This questionnaire also inquired as to the use within these residency programs of standardized resuscitation training courses such as Pediatric Advanced Life Support and Neonatal Resuscitation Program. RESULTS: Residents in their third and second years of training are most often cited as responsible for supervision and teaching of neonatal resuscitation in the delivery room, whereas attending neonatologists are cited most frequently as being responsible for these tasks in the neonatal intensive care unit. Pediatric Advanced Life Support is required by virtually all US residency programs, followed in frequency by Neonatal Resuscitation Program and Advanced Cardiac Life Support. CONCLUSIONS: Because those in training collectively provide much of the supervision and teaching of neonatal resuscitation, vigilance is required so that appropriate resuscitation skills are developed and maintained. Objective performance markers may be useful in assessing competency in caring for sick newborns.neonatal resuscitation, delivery room, Neonatal Resuscitation Program, Pediatric Advanced Life Support, Advanced Cardiac Life Support.

Time for a new paradigm in pediatric medical education: teaching neonatal resuscitation in a simulated delivery room environment.

OBJECTIVES: Acquisition and maintenance of the skills necessary for successful resuscitation of the neonate are typically accomplished by a combination of completion of standardized training courses using textbooks, videotape, and manikins together with active participation in the resuscitation of human neonates in the real delivery room. We developed a simulation-based training program in neonatal resuscitation (NeoSim) to bridge the gap between textbook and real life and to assess trainee satisfaction with the elements of this program. METHODS: Thirty-eight subjects (physicians and nurses) participated in 1 of 9 full-day NeoSim programs combining didactic instruction with active, hands-on participation in intensive scenarios involving life-like neonatal and maternal manikins and real medical equipment. Subjects were asked to complete an extensive evaluation of all elements of the program on its conclusion. RESULTS: The subjects expressed high levels of satisfaction with nearly all aspects of this novel program. Responses to open-ended questions were especially enthusiastic in describing the realistic nature of simulation-based training. The major limitation of the program was the lack of fidelity of the neonatal manikin to a human neonate. CONCLUSION: Realistic simulation-based training in neonatal resuscitation is possible using current technology, is well received by trainees, and offers benefits not inherent in traditional paradigms of medical education.

The effect of passive smoking and tobacco exposure through breast milk on sudden infant death syndrome.

OBJECTIVE: To examine the relationship between sudden infant death syndrome (SIDS) and smoking during pregnancy; postnatal tobacco smoke exposure from the mother, father, live-in-adults, and day care providers; and postnatal smoke exposure from breast-feeding. DESIGN: Case-control study. SETTING: Five counties in Southern California. PARTICIPANTS: A total of 200 white, African-American, Hispanic, and Asian parents of infants who died of SIDS between 1989 and 1992 were compared with 200 control parents who delivered healthy infants. Case infants were matched to control infants on the basis of birth hospital, birth date, gender, and race. All information was obtained from a detailed telephone interview and validated with medical records. MAIN OUTCOME MEASURES: Risk of SIDS associated with passive smoking by the mother, father, live-in adults, and day care providers; smoking in the same room as the infant; total number of cigarettes smoked by all adults; and maternal smoking during the time period of breast-feeding. RESULTS: Conditional logistic regression resulted in overall adjusted odds ratios (ORs) for SIDS associated with passive smoke from the mother of 2.28, the father of 3.46, other live-in adults of 2.18, and all sources of 3.50 (95% confidence interval, 1.81 to 6.75), while simultaneously adjusting for birth weight, sleep position, prenatal care, medical conditions at birth, breast-feeding, and maternal smoking during pregnancy. A dose-response effect was noted for SIDS associated with increasing numbers of cigarettes, as well as total number of smokers. Breast-feeding was protective for SIDS among nonsmokers (OR = 0.37) but not smokers (OR = 1.38), when adjusting for potential confounders. CONCLUSIONS: Passive smoking in the same room as the infant increases the risk for SIDS. Physicians should educate new and prospective parents about the risk of tobacco smoke exposure during pregnancy and the first year of the infant's life.