Mothers' acceptability of using novel technology with video and audio recording during newborn resuscitation: A cross-sectional survey.

OBJECTIVE: This study aims to assess the acceptability of a novel technology, MAchine Learning Application (MALA), among the mothers of newborns who required resuscitation. SETTING: This study took place at Bharatpur Hospital, which is the second-largest public referral hospital with 13 000 deliveries per year in Nepal. DESIGN: This is a cross-sectional survey. DATA COLLECTION AND ANALYSIS: Data collection took place from January 21 to February 13, 2022. Self-administered questionnaires on acceptability (ranged 1-5 scale) were collected from participating mothers. The acceptability of the MALA system, which included video and audio recordings of the newborn resuscitation, was examined among mothers according to their age, parity, education level and technology use status using a stratified analysis. RESULTS: The median age of 21 mothers who completed the survey was 25 years (range 18-37). Among them, 11 mothers (52.4%) completed their bachelor's or master's level of education, 13 (61.9%) delivered first child, 14 (66.7%) owned a computer and 16 (76.2%) carried a smartphone. Overall acceptability was high that all participating mothers positively perceived the novel technology with video and audio recordings of the infant's care during resuscitation. There was no statistical difference in mothers' acceptability of MALA system, when stratified by mothers' age, parity, or technology usage (p>0.05). When the acceptability of the technology was stratified by mothers' education level (up to higher secondary level vs. bachelor's level or higher), mothers with Bachelor's degree or higher more strongly felt that they were comfortable with the infant's care being video recorded (p = 0.026) and someone using a tablet when observing the infant's care (p = 0.046). Compared with those without a computer (n = 7), mothers who had a computer at home (n = 14) more strongly agreed that they were comfortable with someone observing the resuscitation activity of their newborns (71.4% vs. 14.3%) (p = 0.024). CONCLUSION: The novel technology using video and audio recordings for newborn resuscitation was accepted by mothers in this study. Its application has the potential to improve resuscitation quality in low-and-middle income settings, given proper informed consent and data protection measures are in place.

Increased risk of bradycardia in vigorous infants receiving early as compared to delayed cord clamping at birth.

OBJECTIVE: To compare HR pattern of vigorous newborns during the first 180 s with early (≤60 s, ECC) or delayed (>60 s, DCC) cord clamping. STUDY DESIGN: Observational study including dry-electrode ECG monitoring of 610 vaginally-born singleton term and late-preterm (≥34 weeks) who were vigorous after birth. RESULTS: 198 received ECC while 412 received DCC with median cord clamping at 37 s and 94 s. Median HR remained stable from 30 to 180 s with DCC (172 and 170 bpm respectively) but increased with ECC (169 and 184 bpm). The proportion with bradycardia was higher among ECC than DCC at 30 s and fell faster in the DCC through 60 s. After adjusting for factors affecting timing of cord clamping, ECC had significant risk of bradycardia compared to DCC (aRR 1.51; 95% CI; 1.01-2.26). CONCLUSION: Early heart instability and higher risk of bradycardia with ECC as compared to DCC supports the recommended clinical practice of DCC.

Usability, acceptability and feasibility of a novel technology with visual guidance with video and audio recording during newborn resuscitation: a pilot study.

OBJECTIVE: Inadequate adherence to resuscitation for non-crying infants will have poor outcome and thus rationalise a need for real-time guidance and quality improvement technology. This study assessed the usability, feasibility and acceptability of a novel technology of real-time visual guidance, with sound and video recording during resuscitation. SETTING: A public hospital in Nepal. DESIGN: A cross-sectional design. INTERVENTION: The technology has an infant warmer with light, equipped with a tablet monitor, NeoBeat and upright bag and mask. The tablet records resuscitation activities, ventilation sound, heart rate and display time since birth. Healthcare providers (HCPs) were trained on the technology before piloting. DATA COLLECTION AND ANALYSIS: HCPs who had at least 8 weeks of experience using the technology completed a questionnaire on usability, feasibility and acceptability (ranged 1-5 scale). Overall usability score was calculated (ranged 1-100 scale). RESULTS: Among the 30 HCPs, 25 consented to the study. The usability score was good with the mean score (SD) of 68.4% (10.4). In terms of feasibility, the participants perceived that they did not receive adequate support from the hospital administration for use of the technology, mean score (SD) of 2.44 (1.56). In terms of acceptability, the information provided in the monitor, that is, time elapsed from birth was easy to understand with mean score (SD) of 4.60 (0.76). CONCLUSION: The study demonstrates reasonable usability, feasibility and acceptability of a technological solution that records audio visual events during resuscitation and provides visual guidance to improve care.

Can high school students teach their peers high quality cardiopulmonary resuscitation (CPR)?

Background: If adolescents can teach each other cardiopulmonary resuscitation (CPR) during school hours, this may be a cost-effective approach to CPR training. The aim of this study was to evaluate CPR quality among students trained by student instructors in CPR. Material and methods: Three high schools participated. Recruited student instructors (SIs) were given a two-day course by professional instructors. Theoretic knowledge was acquired through an e-learning program. The SIs then trained fellow students in a 90-minute practical CPR session during physical education classes. All participants performed a 4-minutes test of CPR performance. Data was collected using Little Anne QCPR manikins with QCPR classroom software (Laerdal Medical Inc, Norway). Statistical equivalence in CPR performance was assessed applying the two one-sided tests (TOST)-procedure. Results: Eight professional instructors trained 76 SIs who trained approximately 2650 students in CPR. The number of available tests for analysis of student performance was 982. The compression rates were within guideline recommendations for SIs (mean 110.6, SD 5.4) and students (mean 118.6, SD 8.6). The corresponding numbers for mean compression depth were 7.2 cm (SD 0.7) and 7 cm (SD 1.0). Students demonstrated greater variation in mouth-to-mouth (MTM) skills, with only 41% performing at least 15 successful ventilations during the test. Except for the total number of MTM ventilations (mean difference -5.6), CPR performance was deemed statistically equivalent between professional instructors, SIs and students. Conclusions: High school students can be trained as CPR instructors and teach fellow students CPR with good quality, with some variation in MTM-ventilation skills.