Virtual Neonatal Resuscitation Curriculum for Emergency Medical Services (EMS) to Improve Out-of-Hospital Newborn Care.

Objectives: Out-of-hospital births are associated with a 2-to 11-fold increased risk of death compared to in-hospital births and are growing. Emergency Medical Services (EMS) clinicians have limited exposure to hospital birth emergencies, and there is no standardized prehospital neonatal resuscitation curriculum. Neonatal Resuscitation Program (NRP) guidelines are the standard of care for infants born in the United States but focuses on in-hospital births and is not easily applied to EMS.

Characterization of teamwork and guideline compliance in prehospital neonatal resuscitation simulations.

Aim: Neonatal cardiopulmonary arrests are rare but serious events. There is limited information on compliance to best-practice guidelines due to rarity, but deviations can have dire consequences. This research aimed to characterize compliance with and deviations from Neonatal Resuscitation Program (NRP) guidelines and their association with teamwork.

Characterizing prehospital response to neonatal resuscitation.

Objective: To evaluate performance of initial steps of newborn resuscitation according to the American Heart Association and American Academy of Pediatrics' Neonatal Resuscitation Program (NRP) guidelines in the prehospital setting.

Study Design: Observational study of 265 paramedics and Emergency Medical Technicians (EMTs) from 45 EMS teams recruited from public fire and private transport agencies in a major metropolitan area. Participants completed a baseline questionnaire assessing demographics, experience, and comfort in caring for children.

Factors modulating effective chest compressions in the neonatal period.

The need for chest compressions in the newborn is a rare occurrence. The methods employed for delivery of chest compressions have been poorly researched. Techniques that have been studied include compression:ventilation ratios, thumb versus finger method of delivering compressions, depth of compression, site on chest of compression, synchrony or asynchrony of breaths with compressions, and modalities to improve the compression technique and consistency.

The two-thumb technique using an elevated surface is preferable for teaching infant cardiopulmonary resuscitation.

Objectives: To determine whether the two-thumb technique is superior to the two-finger technique for administering chest compressions using the floor surface and the preferred location for performing infant cardiopulmonary resuscitation (CPR) (ie, floor, table, or radiant warmer).

Study Design: Twenty Neonatal Resuscitation Program trained medical personnel performed CPR on a neonatal manikin utilizing the two-thumb vs two-finger technique, a compression to ventilation ratio of 30:2 for 2 minutes in random order on the floor, table, and radiant warmer.

Results: Compression depth favored the two-thumb over two-finger technique on the floor (27 ± 8 mm vs 23 ± 7), table (26 ± 7 mm vs 22 ± 7), and radiant warmer (29 ± 4 mm vs 23 ± 4) (all P < .

Urinary neutrophil gelatinase-associated lipocalin is a promising biomarker for late onset culture-positive sepsis in very low birth weight infants.

Need for the early identification of sepsis in very low birth weight (VLBW) infants has led to the search for reliable biomarkers. This study aims to determine whether urinary neutrophil gelatinase-associated lipocalin (uNGAL) rises in culture-positive sepsis and, if so, is elevated at the time sepsis is suspected. This is a prospective study of 91 VLBW infants whose urine was collected daily for uNGAL analysis.

Reference values of urinary neutrophil gelatinase-associated lipocalin in very low birth weight infants.

In very low birth weight (VLBW) infants, acute renal impairment (ARI) is common, but there is no consensus about criteria for its diagnosis. Neutrophil gelatinase-associated lipocalin (NGAL) is an early and sensitive indicator of renal impairment in experimental animals, children, and adults. Urinary NGAL (UNGAL) is detectable in VLBW infants; however, there is no reference range in this population.