Individualized Skill-Based Manikin Training Coupled with a Team Approach May Enhance Delivery Room Neonatal...

Objectives: We aimed to implement a multi-modal resuscitation curriculum that first focuses on mastering individual skills, followed by team communication training, and study its effect on adherence to neonatal resuscitation steps, including effective bag mask ventilation (BMV) during high-risk deliveries. Methods: This was a single-center prospective observational manikin study conducted in a low-resource regional referral hospital. It included three phases: 1. pre-assessment; 2. individual BMV skill assessment followed by BMV skill testing; and 3. team training with simulation practice. Clinical observations of high-risk deliveries followed. Results: During the pre-assessment, midwives and residents knew when to start BMV but not the parameters for efficacious BMV (such as rate and inflation pressure). Midwives initially outperformed residents in individualized manikin assessments with 88% vs. 27%, p < 0.01, respectively, demonstrating efficacious BMV on the first attempt. However, on BMV testing, midwives more often demonstrated poor BMV performance, as evidenced by a persistent heart rate <100 bpm (31% vs. 8%, p = 0.04, respectively). Ineffective BMV in both groups was often related to low inflation pressures presumed to be in part secondary to a mask leak. Clinical observations demonstrated close adherence to pre-delivery preparation, basic neonatal stabilization, and resuscitation interventions. BMV was effective in most observed resuscitations as evidenced by chest rise and an increase in heart rate. Debriefing was the least performed team-training skill. Conclusions: A multi-modal approach combining individual skills training with team training that focuses on preparation, communication, and immediate skill feedback may enhance neonatal resuscitation in low-resource settings.