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Children
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New Insights in Neonatal Resuscitation
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New Insights in Neonatal Resuscitation

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Neonatology".

Deadline for manuscript submissions: closed (5 May 2025) | Viewed by 6006

Special Issue Editor

Prof. Dr. Georg Schmölzer

E-Mail Website
Guest Editor
Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada
Interests: neonatal hypoxic ischemic encephalopathy; neonatal resuscitation; respiratory distress syndrome; newborns; infants; chronic lung disease; delivery room; resuscitation; chest compression; asphyxia; serious games; cognitive task analysis; eye-tracking

Special Issue Information

Dear Colleagues,

Approximately 10% of newborn infants need help to begin breathing at birth, and ~1% need intensive resuscitative measures to restore cardiorespiratory function. Successful neonatal resuscitation efforts depend on critical actions that must occur in rapid succession to maximize the chances of survival.

This Special Issue aims to provide a comprehensive overview for researchers, practitioners, and healthcare professionals to share and discuss the latest advancements, innovative strategies, and emerging trends in neonatal resuscitation.

This Special Issue seeks to facilitate the dissemination of knowledge that can improve the quality of care and outcomes for newborns requiring resuscitation. We aim to address the following areas: (i) emerging techniques and technologies, (ii) clinical guidelines and protocols, (iii)  quality improvement initiatives, (iv) multidisciplinary approaches, (v) ethical considerations, (vi) global perspectives, (vii) long-term outcomes and follow-up, (viii) education and training, (ix) innovations in preterm resuscitation, and (x) challenges and future directions.

We seek original articles, including randomized trials, observational or cohort studies, randomized animal studies, review articles, systematic reviews and meta-analyses, trial protocols, and surveys.

Prof. Dr. Georg Schmölzer
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • neonatal resuscitation
  • newborn
  • delivery room
  • oxygen
  • cord management
  • respiratory support

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (5 papers)

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Research

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9 pages, 1027 KiB  
Article
Does the Use of an Automated Resuscitation Recorder Improve Adherence to NRP Algorithms and Code Documentation?
by Sarah Nelin, Simon Karam, Elizabeth Foglia, Philip Turk, Venu Peddireddy and Jagdish Desai
Children 2024, 11(9), 1137; https://doi.org/10.3390/children11091137 - 19 Sep 2024
Viewed by 1010
Abstract
Background: Neonatal resuscitation is guided by Neonatal Resuscitation Program (NRP) algorithms; however, human factors affect resuscitation. Video recordings demonstrate that deviations are common. Additionally, code documentation is prone to inaccuracies. Our long-term hypothesis is that the use of an automated resuscitation recorder (ARR) [...] Read more.
Background: Neonatal resuscitation is guided by Neonatal Resuscitation Program (NRP) algorithms; however, human factors affect resuscitation. Video recordings demonstrate that deviations are common. Additionally, code documentation is prone to inaccuracies. Our long-term hypothesis is that the use of an automated resuscitation recorder (ARR) app will improve adherence to NRP and code documentation; the purpose of this study was to determine its feasibility. Methods: We performed a simulation-based feasibility study using simulated code events mimicking NRP scenarios. Teams used the app during resuscitation events. We collected data via an initial demographics survey, video recording, ARR-generated code summary and a post-resuscitation survey. We utilized standardized grading tools to assess NRP adherence and the accuracy of code documentation through resuscitation data point (RDP) scoring. We evaluated provider comfort with the ARR via post-resuscitation survey ordinal ratings and open-ended question text mining. Results: Summary statistics for each grading tool were computed. For NRP adherence, the median was 68% (range 60–76%). For code documentation accuracy and completeness, the median was 77.5% (range 55–90%). When ordinal ratings assessing provider comfort with the app were reviewed, 47% chose “agree” (237/500) and 36% chose “strongly agree” (180/500), with only 0.6% (3/500) answering “strongly disagree”. A word cloud compared frequencies of words from the open-ended text question. Conclusions: We demonstrated the feasibility of ARR use during neonatal resuscitation. The median scores for each grading tool were consistent with passing scores. Post-resuscitation survey data showed that participants felt comfortable with the ARR while highlighting areas for improvement. A pilot study comparing ARR with standard of care is the next step. Full article
(This article belongs to the Special Issue New Insights in Neonatal Resuscitation)
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10 pages, 219 KiB  
Article
Assessment of Visual Attention in Teams with or without Dedicated Team Leaders: A Neonatal Simulation-Based Pilot Randomised Cross-Over Trial Utilising Low-Cost Eye-Tracking Technology
by Prakash Kannan Loganathan, Anip Garg, Robert McNicol, Conor Wall, Matthew Pointon, Peter McMeekin, Alan Godfrey, Michael Wagner and Charles Christoph Roehr
Children 2024, 11(8), 1023; https://doi.org/10.3390/children11081023 - 21 Aug 2024
Cited by 1 | Viewed by 1113
Abstract
Background: Eye-tracking technology could be used to study human factors during teamwork. Objectives: This work aimed to compare the visual attention (VA) of a team member acting as both a team leader and managing the airway, compared to a team member performing the [...] Read more.
Background: Eye-tracking technology could be used to study human factors during teamwork. Objectives: This work aimed to compare the visual attention (VA) of a team member acting as both a team leader and managing the airway, compared to a team member performing the focused task of managing the airway in the presence of a dedicated team leader. This work also aimed to report differences in team performance, behavioural skills, and workload between the two groups using validated tools. Methods: We conducted a simulation-based, pilot randomised controlled study. The participants included were volunteer paediatric trainees, nurse practitioners, and neonatal nurses. Three teams consisting of four team members were formed. Each team participated in two identical neonatal resuscitation simulation scenarios in a random order, once with and once without a team leader. Using a commercially available eye-tracking device, we analysed VA regarding attention to (1) a manikin, (2) a colleague, and (3) a monitor. Only the trainee who was the airway operator would wear eye-tracking glasses in both simulations. Results: In total, 6 simulation scenarios and 24 individual role allocations were analysed. Participants in a no-team-leader capacity had a greater number of total fixations on manikin and monitors, though this was not significant. There were no significant differences in team performance, behavioural skills, and individual workload. Physical demand was reported as significantly higher by participants in the group without a team leader. During debriefing, all the teams expressed their preference for having a dedicated team leader. Conclusion: In our pilot study using low-cost technology, we could not demonstrate the difference in VA with the presence of a team leader. Full article
(This article belongs to the Special Issue New Insights in Neonatal Resuscitation)
15 pages, 1811 KiB  
Article
A Randomized Controlled Simulation Trial of a Neonatal Resuscitation Digital Game Simulator for Labour and Delivery Room Staff
by Christiane Bilodeau, Georg M. Schmölzer and Maria Cutumisu
Children 2024, 11(7), 793; https://doi.org/10.3390/children11070793 - 28 Jun 2024
Cited by 1 | Viewed by 1134
Abstract
Background: Healthcare providers (HCPs) working in labour and delivery rooms need to undergo regular refresher courses to maintain their neonatal resuscitation skills, which are shown to decline over time. However, due to their irregular schedules and limited time, HCPs encounter difficulties in readily [...] Read more.
Background: Healthcare providers (HCPs) working in labour and delivery rooms need to undergo regular refresher courses to maintain their neonatal resuscitation skills, which are shown to decline over time. However, due to their irregular schedules and limited time, HCPs encounter difficulties in readily accessing refresher programs. RETAIN is a digital game that simulates a delivery room to facilitate neonatal resuscitation training for HCPs. Objective: This study aims to ascertain whether participants enjoyed the RETAIN digital game simulator and whether it was at least as good as a video lecture at refreshing and maintaining participants’ neonatal resuscitation knowledge. Methods: In this randomized controlled simulation trial, n = 42 labour and delivery room HCPs were administered a pre-test of neonatal resuscitation knowledge using a manikin. Then, they were randomly assigned to a control or a treatment group. For 20–30 min, participants in the control group watched a neonatal resuscitation lecture video, while those in the treatment group played the RETAIN digital game simulator of neonatal resuscitation scenarios. Then, all participants were administered a post-test identical to the pre-test. Additionally, participants in the treatment group completed a survey of attitudes toward the RETAIN simulator that provided a measure of enjoyment of the RETAIN game simulator. After two months, participants were administered another post-test identical to the pre-test. Results: For the primary outcome (neonatal resuscitation performance), an analysis of variance revealed that participants significantly improved their neonatal resuscitation performance over the first two time points, with a significant decline to the third time point, the same pattern of results across conditions, and no differences between conditions. For the secondary outcome (attitudes toward RETAIN), participants in the treatment condition also reported favourable attitudes toward RETAIN. Conclusions: Labour and delivery room healthcare providers in both groups (RETAIN simulator or video lecture) significantly improved their neonatal resuscitation performance immediately following the intervention, with no group differences. The findings suggest that participants enjoyed interacting with the RETAIN digital game simulator, which provided a similar boost in performance right after use to the more traditional intervention. Full article
(This article belongs to the Special Issue New Insights in Neonatal Resuscitation)
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8 pages, 192 KiB  
Article
Electronic Heart (ECG) Monitoring at Birth and Newborn Resuscitation
by Sarah Mende, Syed Ahmed, Lise DeShea, Edgardo Szyld and Birju A. Shah
Children 2024, 11(6), 685; https://doi.org/10.3390/children11060685 - 4 Jun 2024
Viewed by 1474
Abstract
Background: Approximately 10% of newborns require assistance at delivery, and heart rate (HR) is the primary vital sign providers use to guide resuscitation methods. In 2016, the American Heart Association (AHA) suggested electrocardiogram in the delivery room (DR-ECG) to measure heart rate during [...] Read more.
Background: Approximately 10% of newborns require assistance at delivery, and heart rate (HR) is the primary vital sign providers use to guide resuscitation methods. In 2016, the American Heart Association (AHA) suggested electrocardiogram in the delivery room (DR-ECG) to measure heart rate during resuscitation. This study aimed to compare the frequency of resuscitation methods used before and after implementation of the AHA recommendations. Methods: This longitudinal retrospective cohort study compared a pre-implementation (2015) cohort with two post-implementation cohorts (2017, 2021) at our Level IV neonatal intensive care unit. Results: An initial increase in chest compressions at birth associated with the introduction of DR-ECG monitoring was mitigated by focused educational interventions on effective ventilation. Implementation was accompanied by no changes in neonatal mortality. Conclusions: Investigation of neonatal outcomes during the ongoing incorporation of DR-ECG may help our understanding of human and system factors, identify ways to optimize resuscitation team performance, and assess the impact of targeted training initiatives on clinical outcomes. Full article
(This article belongs to the Special Issue New Insights in Neonatal Resuscitation)

Review

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16 pages, 257 KiB  
Review
Addressing the Humans in the Delivery Room—Optimising Neonatal Monitoring and Decision-Making in Transition
by Christoph E. Schwarz, Bernhard Schwaberger, Alice Iride Flore, Robert Joyce, Simon Woodworth, Frederic Adam and Eugene M. Dempsey
Children 2025, 12(4), 402; https://doi.org/10.3390/children12040402 - 22 Mar 2025
Viewed by 548
Abstract
During the first minutes of life, complex dynamic processes occur, facilitating a normal transition to ex utero life. In healthy term infants, these processes typically occur with minimal intervention required but are often more challenging for the preterm infant. These challenges involve not [...] Read more.
During the first minutes of life, complex dynamic processes occur, facilitating a normal transition to ex utero life. In healthy term infants, these processes typically occur with minimal intervention required but are often more challenging for the preterm infant. These challenges involve not only the physiological processes encountered but also an organizational process: that of a team of healthcare providers led by a neonatologist, establishing a diagnosis based on clinical and technical information and initiating time-critical and potentially life-altering interventions. In this narrative review, we highlight the challenges of both processes. We explore the role and limitations of well-established and newer potential monitoring modalities, in particular respiratory function monitoring and cerebral near-infrared spectroscopy, to optimally inform the team in regards to physiological processes. We also evaluate the important role that human factors play in the process of decision-making. Both are important for optimal performance to enable successful transition and thereby reduce short- and long-term problems. We identify research goals to inform future studies to further optimize technological and human aspects in the first minutes of life. Full article
(This article belongs to the Special Issue New Insights in Neonatal Resuscitation)
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