Eye-tracking in the delivery room: visual and communication patterns during neonatal transition

Beside technical skills, also cognitive processes and communication may influence newborn transition. We evaluate whether team leader's visual attention (VA) to areas of interest (AOI) correlates with experience and communication patterns in the delivery room management of newborn babies. Observational study using eye-tracking glasses (Tobii Pro®) in seventeen neonatal transitions. VA: fixations, fixation time, dwell time, visits; AOI: infant's head, chest, monitor, resuscitation bay, healthcare providers (HCP), elsewhere. Communication: direct, closed-loop, inclusive leader and speaking up. Data were analyzed in Period 1: 0-1 min, Period 2: 2-5 min, Period 3: 6-10 min after birth. VA shifted over time from infant's head to chest to an even distribution. In Period 1, team leaders focused predominantly on the infant's head (24.0% of dwell time) and looked elsewhere (22.0%). In Period 2, visual attention shifted to the chest (37.5%) and head (27.7%). In Period 3, attention was still on the head (24.7%) and chest (23.8%), but fixations became more evenly distributed with other HCP (15.23%) and elsewhere (13.9%) More communication significantly correlated with longer time on chest (r_s = 0.503, P = .04), shorter on head (r_s =  - 0.591, P = .012) and significantly with greater clinical experience (r_s = 0.590, P = .013), lower Apgar (r_s =  - 0.703, P = .002), and Combined Apgar Scores (r_s =  - 0.791, P = .001) at 10 min.

Combining eye-tracking data with communication analysis provides novel insights into team leader performance during neonatal transition. Professional experience, visual attention, and structured communication are closely interrelated and may influence and be influenced by the clinical condition of the newborn babies. Our findings provide a rationale for future studies evaluating whether interventions targeting communication skills can improve team performance during neonatal stabilization.

• Eye-tracking technology has emerged as an objective method for investigating visual attention, situational awareness, and cognitive processes during the management of neonatal transition. To date, the majority of published studies have been conducted in simulation environments rather than during live clinical care.

• This is the first study to describe the interplay of clinical experience, visual attention, and structured communication in the first 10 min of life of preterm and term-born infants in a real clinical situation.