Characterizing continuous positive airway pressure (CPAP) Belly Syndrome in preterm infants in the neonatal intensive care unit (NICU).

Objective: Reproducibly define CPAP Belly Syndrome (CBS) in preterm infants and describe associated demographics, mechanical factors, and outcomes.

Study Design: A retrospective case-control study was conducted in infants <32 weeks gestation in the Stanford Children's NICU from January 1, 2020 to December 31, 2021. CBS was radiographically defined by a pediatric radiologist.

In Situ Simulation and Clinical Outcomes in Infants Born Preterm.

Objective: To evaluate impact of a multihospital collaborative quality improvement project implementing in situ simulation training for neonatal resuscitation on clinical outcomes for infants born preterm.

Study Design: Twelve neonatal intensive care units were divided into 4 cohorts; each completed a 15-month long program in a stepped wedge manner. Data from California Perinatal Quality Care Collaborative were used to evaluate clinical outcomes.

Neonatal Healthcare Professionals' Experiences When Implementing a Simulation and Debriefing Program in Neonatal Intensive Care Settings: A Qualitative Analysis.

Background: Simulation-based training (SBT) and debriefing have increased in healthcare as a method to conduct interprofessional team training in a realistic environment.

Purpose: This qualitative study aimed to describe the experiences of neonatal healthcare professionals when implementing a patient safety simulation and debriefing program in a neonatal intensive care unit (NICU).

Methods: Fourteen NICUs in California and Oregon participated in a 15-month quality improvement collaborative with the California Perinatal Quality Care Collaborative.

The Evolution of Neonatal Patient Safety.

Human factors science teaches us that patient safety is achieved not by disciplining individual health care professionals for mistakes, but rather by designing systems that acknowledge human limitations and optimize the work environment for them. Incorporating human factors principles into simulation, debriefing, and quality improvement initiatives will strengthen the quality and resilience of the process improvements and systems changes that are developed. The future of patient safety in neonatology will require continued efforts to engineer and re-engineer systems that support the humans who are at the interface of delivering safe patient care.

A Novel Method for Administering Epinephrine during Neonatal Resuscitation.

Objective: This study aimed to determine if prefilled epinephrine syringes will reduce time to epinephrine administration compared with conventional epinephrine during standardized simulated neonatal resuscitation.

Study Design: Timely and accurate epinephrine administration during neonatal resuscitation is lifesaving in bradycardic infants. Current epinephrine preparation is inefficient and error-prone.

The Debriefing Assessment in Real Time (DART) tool for simulation-based medical education.

Background: Debriefing is crucial for enhancing learning following healthcare simulation. Various validated tools have been shown to have contextual value for assessing debriefers. The Debriefing Assessment in Real Time (DART) tool may offer an alternative or additional assessment of conversational dynamics during debriefings.

Respiratory function monitoring during neonatal resuscitation: A systematic review.

Aim: Positive pressure ventilation via a facemask is critical in neonatal resuscitation, but frequently results in mask leak, obstruction, and inadequate respiratory support. This systematic review aimed to determine whether the display of respiratory function monitoring improved resuscitation or clinical outcomes.

Methods: Randomized controlled trials comparing outcomes when respiratory function monitoring was displayed versus not displayed for newborns requiring positive pressure ventilation at birth were selected and from databases (last search August 2022), and assessed for risk of bias using Cochrane Risk of Bias Tools for randomized control trials.

Using Simulation to Support Evidence-Based Design of Safer Health Care Environments.

The design of health care environments and the technologies used within them have tremendous influence on the performance of the professionals who care for patients in those spaces. In turn, the performance of those professionals greatly impacts the safety of the care that is delivered to patients. Active and latent safety errors can be greatly reduced by rigorous testing of the patient care environment.

A Scoping Review and Appraisal of Extracorporeal Membrane Oxygenation Education Literature.

Background: Despite a recent rise in publications describing extracorporeal membrane oxygenation (ECMO) education, the scope and quality of ECMO educational research and curricular assessments have not previously been evaluated.

Objective: The purposes of this study are ) to categorize published ECMO educational scholarship according to Bloom's educational domains, learner groups, and content delivery methods; ) to assess ECMO educational scholarship quality; and ) to identify areas of focus for future curricular development and educational research.

Methods: A multidisciplinary research team conducted a scoping review of ECMO literature published between January 2009 and October 2021 using established frameworks.

Pilot study of the DART tool - an objective healthcare simulation debriefing assessment instrument.

Background: Various rating tools aim to assess simulation debriefing quality, but their use may be limited by complexity and subjectivity. The Debriefing Assessment in Real Time (DART) tool represents an alternative debriefing aid that uses quantitative measures to estimate quality and requires minimal training to use. The DART is uses a cumulative tally of instructor questions (IQ), instructor statements (IS) and trainee responses (TR).

State-of-the art training in neonatal resuscitation.

Healthcare training has traditionally emphasized acquisition and recall of vast amounts of content knowledge; however, delivering care during resuscitation of neonates requires much more than content knowledge. As the science of resuscitation has progressed, so have the methodologies and technologies used to train healthcare professionals in the cognitive, technical and behavioral skills necessary for effective resuscitation. Simulation of clinical scenarios, debriefing, virtual reality, augmented reality and audiovisual recordings of resuscitations of human neonates are increasingly being used in an effort to improve human and system performance during this life-saving intervention.

Immediate faculty feedback using debriefing timing data and conversational diagrams.

Background: Debriefing is an essential skill for simulation educators and feedback for debriefers is recognised as important in progression to mastery. Existing assessment tools, such as the Debriefing Assessment for Simulation in Healthcare (DASH), may assist in rating performance but their utility is limited by subjectivity and complexity. Use of quantitative data measurements for feedback has been shown to improve performance of clinicians but has not been studied as a focus for debriefer feedback.

Impact of bed height on the biomechanics of healthcare professionals during chest compressions on the neonate: a descriptive pilot study.

Objectives: The biomechanics of the healthcare professionals (HCPs) performing the life-saving intervention of chest compressions in the neonatal population is poorly understood. The aim of this pilot study was to describe the variations in body position at a self-selected and a predetermined bed height during neonatal chest compressions. Measures of joint angles, time to postural sway and number of postural adjustments were chosen as indices for the stability of the HCP's position.

Single-center task analysis and user-centered assessment of physical space impacts on emergency Cesarean delivery.

Objective: This study aimed to begin to address this gap using validated techniques in human factors to perform a participatory user-centered analysis of physical space during emergency Cesarean.

Methods: This study employed a mixed-methods design. Focus group interviews and surveys were administered to a convenience sample (n = 34) of multidisciplinary obstetric teams.

A Feasibility Study of a Novel Delayed Cord Clamping Cart.

Delaying umbilical cord clamping (DCC) for 1 min or longer following a neonate's birth has now been recommended for preterm and term newborns by multiple professional organizations. DCC has been shown to decrease rates of iron deficiency anemia, intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and blood transfusion. Despite these benefits, clinicians typically cut the umbilical cord without delay in neonates requiring resuscitation and move them to a radiant warmer for further care; this effectively prevents these patients from receiving any benefits from DCC.

Lessons Learned from a Collaborative to Develop a Sustainable Simulation-Based Training Program in Neonatal Resuscitation: Simulating Success.

Newborn resuscitation requires a multidisciplinary team effort to deliver safe, effective and efficient care. California Perinatal Quality Care Collaborative's Simulating Success program was designed to help hospitals implement on-site simulation-based neonatal resuscitation training programs. Partnering with the Center for Advanced Pediatric and Perinatal Education at Stanford, Simulating Success engaged hospitals over a 15 month period, including three months of preparatory training and 12 months of implementation.

A Neonatal Intensive Care Unit's Experience with Implementing an In-Situ Simulation and Debriefing Patient Safety Program in the Setting of a Quality Improvement Collaborative.

Extensive neonatal resuscitation is a high acuity, low-frequency event accounting for approximately 1% of births. Neonatal resuscitation requires an interprofessional healthcare team to communicate and carry out tasks efficiently and effectively in a high adrenaline state. Implementing a neonatal patient safety simulation and debriefing program can help teams improve the behavioral, cognitive, and technical skills necessary to reduce morbidity and mortality.

Validation of an Instrument for Real-Time Assessment of Neonatal Intubation Skills: A Randomized Controlled Simulation Study.

Objective: This study aimed to evaluate the construct validity and reliability of real-time assessment of a previously developed neonatal intubation scoring instrument (NISI).

Study Design: We performed a randomized controlled simulation study at a simulation-based research and training facility. Twenty-four clinicians experienced in neonatal intubation ("experts") and 11 medical students ("novices") performed two identical elective intubations on a neonatal patient simulator.

Using briefing, simulation and debriefing to improve human and system performance.

Safety, effectiveness and efficiency are keys to performance in all high-risk industries; healthcare is no exception, and neonatal-perinatal medicine is one of the highest risk subspecialties within healthcare. Briefing, simulation and debriefing are methods used by professionals in high-risk industries to reduce the overall risk to life and enhance the safety of the human beings involved in receiving and delivering the services provided by those industries. Although relatively new to neonatal-perinatal medicine, briefing, simulation and debriefing are being practiced with increasing frequency and have become embedded in training exercises such as the Neonatal Resuscitation Program (NRP) of the American Academy of Pediatrics (AAP).

Simulation in Neonatal-Perinatal Medicine Fellowship Programs.

Objective: This study aimed to investigate the use of simulation in neonatal-perinatal medicine (NPM) fellowship programs.

Study Design: This was a cross-sectional survey of program directors (PDs) and simulation educators in Accreditation Council for Graduate Medical Education (ACGME) accredited NPM fellowship programs.

Results: Responses were received from 59 PDs and 52 simulation educators, representing 60% of accredited programs.

Ergonomic Challenges Inherent in Neonatal Resuscitation.

Neonatal resuscitation demands that healthcare professionals perform cognitive and technical tasks while working under time pressure as a team in order to provide efficient and effective care. Neonatal resuscitation teams simultaneously process and act upon multiple data streams, perform ergonomically challenging technical procedures, and coordinate their actions within a small physical space. An understanding and application of human factors and ergonomics science broadens the areas of need in resuscitation research, and will lead to enhanced technologies, systems, and work environments that support human limitations and maximize human performance during neonatal resuscitation.

Understanding the Heterogeneity of Labor and Delivery Units: Using Design Thinking Methodology to Assess Environmental Factors that Contribute to Safety in Childbirth.

Objective: There is limited research exploring the relationship between design and patient safety outcomes, especially in maternal and neonatal care. We employed design thinking methodology to understand how the design of labor and delivery units impacts safety and identified spaces and systems where improvements are needed.

Study Design: Site visits were conducted at 10 labor and delivery units in California.

Appraisal of a scoring instrument for training and testing neonatal intubation skills.

Objective: To determine the validity, reliability, feasibility and applicability of a neonatal intubation scoring instrument.

Design: Prospective observational study.

Setting: Simulation-based research and training centre (Center for Advanced Pediatric and Perinatal Education), California, USA.