Predictive validity of bag and mask ventilation scores in neonatal resuscitation

Background: All personnel dealing with the birth of a newborn infant need to pass Neonatal Resuscitation Program (NRP) course .The validity of the certificate is for 2 years. Evaluation is done on various items learned at the course. All items are scored on scale of 0-2 on a form called megacode assessment form. Some items are mandatory and some non-mandatory. Bag and mask ventilation is one of the key skills acquired at the course. Objectives This study examined the predictive validity of the scores achieved in bag and mask ventilation skill during a formal neonatal resuscitation course and its impact over course of time. Methods This was a Prospective cohort study. 20 third year medical students were enrolled. Two simulated NRP scenarios over 6-8 months were offered and videotaped. Low fidelity manikins were similar to the one used in NRP course. Investigators and the independent rater (Neonatal Nurse Educator) were blinded to original scores. Video recordings scored on megacode forms by the independent rater. Total of 5 items scored, 3 items were mandatory and 2 non-mandatory. Original scores were then requested from the provincial NRP coordinator to compare with the study outcomes. Results The enrolled students had all similar original scores during NRP program (T1); everyone had 10/10 scores for bag and mask ventilation skill. R was constant and not calculated by SPSS. 5 students dropped out of the study. Pearson’s r values were calculated for the first study session (T2) and second study session (T3). The 3 mandatory and 5 total bag and mask ventilation skill items were grouped and compared for the two study sessions. The sum of 3 mandatory items for the two study sessions showed Pearson’s r of 0.299 for n=15, p value of 0.279, the sum of 5 total items showed Pearson’s r of 0.188 and p value of 0.502 Analysis of variance (ANOVA) for pairwise comparison of the means was calculated.T1-T2 Anova for sum of 5 total items showed a very low p value of 0.000 whereas T1-T3 Anova for sum of 5 total items showed p Value of 0.001 T1-T2 as well as T1-T3 Anova for sum of 3 mandatory items showed very low p values of 0.000 Conclusion Most candidates lost BMV skills significantly within 6 months. Practice resuscitation (T2), improved the skill slightly but not significantly. The NRP scores on bag and mask ventilation does not have a good predictive value. More research is required to evaluate alternate ways to enhance retention of acquired skills at the NRP program

Examination of the effect of low versus high fidelity simulation of Neonatal Resuscitation Program (NRP) learning outcomes

Background Approximately 6% of all newborns and up to 80% of infants weighing less than 1,500 grams require some resuscitation intervention at birth and the quality of care provided at that time can have a significant impact on the outcome of that life. The Neonatal Resuscitation Program (NRP), introduced in Newfoundland and Labrador (NL) in the early 1990’s, has been developed to educate physicians and other health care providers about newborn resuscitation. Several studies have examined the use of simulation in resuscitation training, but few have compared low and high-fidelity simulation for NRP learning outcomes. Objectives To examine the effect of using low versus high-fidelity manikin simulators for NRP training on medical student knowledge, skill, confidence, and teamwork performance. Methods Randomized posttest-only control group study; experimental group received NRP instruction and megacode assessment using a high-fidelity manikin simulator, while control group received NRP instruction and megacode assessment using a low-fidelity manikin simulator. Students completed: performance skills stations; a megacode skills assessment; and teamwork simulation scenario. As part of participating in the study, students were asked to complete participant evaluation and confidence surveys. Their teamwork simulation (which was recorded and used for debriefing during training) was provided to two raters who examined teamwork characteristics and functioning. Results Sixty-six (N=66) medical students participated in NRP and the study (N=31 high fidelity and N=35 low-fidelity). Participant megacode, satisfaction, and confidence data has been collected. Preliminary analysis indicates that students who received NRP training using the high-fidelity simulator report a higher degree of confidence in performing various skills related to NRP. Conclusions In 2003, the International Liaison Committee on Resuscitation (ILCOR) recommended that high-fidelity simulation-directed training should increasingly supplement instructor-directed training in advanced life support/advanced cardiac support.3 High-fidelity training has the potential to add more realism to NRP training, thereby increasing participant satisfaction and confidence, and in turn, improving learning and patient health outcomes

Examination of the Effect of Low versus High-Fidelity Simulation on Neonatal Resuscitation Program (NRP) Learning Outcomes: Final Report of Study Findings

The purpose of this study was to examine the effect of using low versus high-fidelity manikin simulators in Neonatal Resuscitation Program (NRP) instruction. Low and high-fidelity manikin simulators provide trainees with an opportunity to learn, practice and demonstrate neonatal resuscitation skills in a learning environment which simulates the experiences involved with real resuscitation emergencies. High-fidelity manikin simulator systems have been developed which approximate a full-term newborn in size and weight, possess a realistic airway that can be intubated, lungs that can be inflated with positive pressure ventilation, and an umbilical cord containing a single vein and 2 arteries that allow insertion of umbilical venous and arterial catheters. Integrated computer programs allow primary cues important for accurate assessment of the neonate (heart rate, respiratory rate, and skin color) to be controlled remotely. In 2003, the International Liaison Committee on Resuscitation (ILCOR) recommended that high-fidelity simulation-directed training should increasingly supplement instructor-directed training in advanced life support/advanced cardiac support (Chamberlain & Hazinski, 2003). Several studies have examined the use of simulation in resuscitation training and specifically compared the utility and effectiveness of low and high-fidelity simulation. However, few studies have compared low and high-fidelity simulation for NRP learning outcomes, and more specifically on team performance and confidence. This study was funded by a grant from the Janeway Children’s Hospital Foundation, Research Advisory Committee. It was led and managed by Professional Development & Conferencing Services (PDCS), Faculty of Medicine, Memorial University, as well as a team of study investigators (see Section 1.1). Ethics approval was received from the Interdisciplinary Committee on Ethics in Human Research (ICEHR), Memorial University

Association of Antibiotic Utilization and Neurodevelopmental Outcomes among Extremely Low Gestational Age Neonates without Proven Sepsis or Necrotizing Enterocolitis

Objective The objective is to evaluate the association between antibiotic utilization and neurodevelopmental outcomes at 18 to 21 months' corrected age among extremely low gestational age neonates without culture-proven sepsis or necrotizing enterocolitis (NEC). Study Design We conducted a retrospective cohort study of infants born between April 2009 and September 2011 at &lt;29 weeks' gestation and admitted to the neonatal intensive care units contributing data to the Canadian Neonatal Network. Multivariable analysis was performed to examine the primary composite outcome of death or significant neurodevelopmental impairment (sNDI) in infants with various antibiotic utilization rates (AURs). Result There were 1,373 infants who fulfilled our inclusion criteria. Compared with infants in the lowest AUR quartile (Q1), those in the highest quartile (Q4) had higher odds of death or sNDI (adjusted odds ratio [AOR] = 7.44; 95% confidence interval [CI]: 4.55, 12.2) and death (AOR = 39.3; 95% CI: 16.1, 95.9). Conclusion Our results indicate an association between high AUR and a composite outcome of death or adverse neurodevelopmental outcomes at 18 to 21 months' corrected age.</jats:p