Time to Effective Ventilation in Neonatal Manikins with a Supraglottic Airway vs. a Facemask: A Randomized Controlled Trial.

(1) Background: Timely and effective positive pressure ventilation (PPV) is the most important component of neonatal resuscitation. Emerging data supports the use of supraglottic airways such as the laryngeal mask airway (LMA) as a first-line interface for PPV during neonatal resuscitation. LMA use reduces the need for intubation compared to facemask use in systematic reviews, but there is no difference in the incidence of death or moderate-to-severe hypoxic ischemic encephalopathy (HIE). Time to effective ventilation during simulation with manikin models by providers with limited neonatal airway experience may add to the current evidence that compares the LMA to the neonatal facemask as the first-line ventilation interface during neonatal resuscitation.; (2) Methods: Thirty-two pre-clinical medical students were recruited and randomized to learning and performing ventilation with either the LMA or neonatal facemask on a neonatal manikin. Tidal volume was measured by breath-by-breath analysis to assess adequacy and consistency of PPV in 10 consecutive breaths. Perceived confidence was measured by pre- and post-intervention surveys that utilized a Likert scale from 1 to 5.; (3) Results: Median time to achieve effective ventilation was shorter with a neonatal facemask compared to the LMA (43 (30, 112) seconds vs. 82 (61, 264) seconds, p < 0.01). Participants reported higher perceived confidence post-intervention with use of a facemask when compared to use of the LMA (5 (4, 5) vs. 4 (4, 4), p = 0.03).; (4) Conclusions: Pre-clinical medical students demonstrated a shorter time to effective ventilation and reported higher confidence scores after learning and demonstrating PPV using the facemask when compared to LMA in a neonatal manikin. Further studies are warranted to evaluate the use of supraglottic airways in providers with limited experience with airway management of neonates, as well as in ways to better promote proficiency and confidence in the use of the LMA.

Relationship Between Self-efficacy and Performance of Simulated Neonatal Chest Compressions and Ventilation.

INTRODUCTION: Because improved competence in caring for patients is difficult to measure, self-efficacy (the strength of one's belief in one's ability to complete a task) is often used as a surrogate measurement of clinical ability. However, studies in adults and children have shown at best only weak correlations between self-efficacy and performance. This correlation has not been well studied in neonatal resuscitation limiting the utility of self-efficacy as a measurement of the effectiveness of interventions in this population. The objective of this study was to determine whether self-efficacy correlates with performance of simulated neonatal chest compressions and ventilation. METHODS: Sixty-nine neonatal fellows, neonatal nurse practitioners, neonatologists, and nurses completed a 7-point Likert scale in which they reported their ability to perform ventilations and chest compressions. The participants then performed chest compressions and bag-valve-mask ventilation on a mannequin. The performance of participants was compared with the rating of their ability using Spearman rank correlation coefficient. RESULTS: There was no correlation between participants' self-assessment and performance of chest compressions (rs = 0.003) or bag-valve-mask ventilation (rs = 0.08). There was a correlation between experience (years of neonatal intensive care unit experience, number of mock codes, and number of real codes) and the ratings of self-efficacy as well as between the number of mock codes and ventilation performance. CONCLUSIONS: In this study, self-reported efficacy had no correlation to clinical skills in neonatal resuscitation; participants both overestimated and underestimated their clinical proficiency. Prior participation in mock codes in the neonatal intensive care unit was the only factor that correlated with resuscitation performance.

The Impact of Telemedicine on Transfer Rates of Newborns at Rural Community Hospitals.

BACKGROUND AND OBJECTIVE: Telemedicine may have the ability to reduce avoidable transfers by allowing remote specialists the opportunity to more effectively assess patients during consultations. In this study, we examined whether telemedicine consultations were associated with reduced transfer rates compared to telephone consultations among a cohort of term and late preterm newborns. We hypothesized that neonatologist consultations conducted over telemedicine would result in fewer interfacility transfers than consultations conducted over telephone. METHODS: We collected data on all newborns who received a neonatal telemedicine or telephone consultation at 6 rural hospitals in northern and central California between August 2014 and June 2018. We used adjusted analyses to compare transfer rates between telemedicine and telephone cohorts. RESULTS: A total of 317 patients were included in the analysis; 89 (28.1%) of these patients received a telemedicine consultation and 228 (71.9%) received a telephone consultation only. The overall transfer rate was 77.0%. Patient consultations conducted using telemedicine were significantly less likely to result in a transfer than patient consultations conducted using the telephone (64.0% vs 82.0%, P = .001). After controlling for 5-minute Apgar score, birthweight, gestational age, site of consultation, and Transport Risk Index of Physiologic Stability score, the odds of transfer for telemedicine consultations was 0.48 (95% confidence interval: 0.26, 0.90, P = .02). CONCLUSIONS: Our findings suggest that telemedicine may have the potential to reduce potentially avoidable transfers of term and late preterm newborns. Future research on potentially avoidable transfers and patient outcomes is needed to better understand the ways in which telemedicine affects clinical decision-making.

Use of Telemedicine to Improve Neonatal Resuscitation.

Most newborn infants do well at birth; however, some require immediate attention by a team with advanced resuscitation skills. Providers at rural or community hospitals do not have as much opportunity for practice of their resuscitation skills as providers at larger centers and are, therefore, often unable to provide the high level of care needed in an emergency. Education through telemedicine can bring additional training opportunities to these rural sites in a low-resource model in order to better prepare them for advanced neonatal resuscitation. Telemedicine also offers the opportunity to immediately bring a more experienced team to newborns to provide support or even lead the resuscitation. Telemedicine can also be used to train and assist in the performance of emergent procedures occasionally required during a neonatal resuscitation including airway management, needle thoracentesis, and umbilical line placement. Telemedicine can provide unique opportunities to significantly increase the quality of neonatal resuscitation and stabilization in rural or community hospitals.