Laryngeal mask use during neonatal resuscitation at birth: A United States-based survey of neonatal resuscitation program providers and instructors

Aim

Neonatal resuscitation guidelines promote the laryngeal mask (LM) interface for positive pressure ventilation (PPV), but little is known about how the LM is used among Neonatal Resuscitation Program (NRP) Providers and Instructors. The study aim was to characterize the training, experience, confidence, and perspectives of NRP Providers and Instructors regarding LM use during neonatal resuscitation at birth.

Methods

A voluntary anonymous survey was emailed to all NRP Providers and Instructors. Survey items addressed training, experience, confidence, and barriers for LM use during resuscitation. Associations between respondent characteristics and outcomes of both LM experience and confidence were assessed using logistic regression.

Results

Between 11/7/22-12/12/22, there were 5,809 survey respondents: 68% were NRP Providers, 55% were nurses, and 87% worked in a hospital setting. Of these, 12% had ever placed a LM during newborn resuscitation, and 25% felt very or completely confident using a LM. In logistic regression, clinical or simulated hands-on training, NRP Instructor role, professional role, and practice setting were all associated with both LM experience and confidence.The three most frequently identified barriers to LM use were insufficient experience (46%), preference for other interfaces (25%), and failure to consider the LM during resuscitation (21%). One-third (33%) reported that LMs are not available where they resuscitate newborns.

Conclusion

Few NRP providers and instructors use the LM during neonatal resuscitation. Strategies to increase LM use include hands-on clinical training, outreach promoting the advantages of the LM compared to other interfaces, and improving availability of the LM in delivery settings.

Updates for the Neonatal Resuscitation Program and Resuscitation Guidelines

Although most newborns require no assistance to successfully transition to extrauterine life, the large number of births each year and limited ability to predict which newborns will need assistance means that skilled clinicians must be prepared to respond quickly and efficiently for every birth. A successful outcome is dependent on a rapid response from skilled staff who have mastered the cognitive, technical, and behavioral skills of neonatal resuscitation. Since its release in 1987, over 4.5 million clinicians have been trained by the American Heart Association and American Academy of Pediatrics Neonatal Resuscitation Program®. The guidelines used to develop this program were updated in 2020 and the Textbook of Neonatal Resuscitation, 8th edition, was released in June 2021. The updated guidelines have not changed the basic approach to neonatal resuscitation, which emphasizes the importance of anticipation, preparation, teamwork, and effective ventilation. Several practices have changed, including the prebirth questions, initial steps, use of electronic cardiac monitors, the initial dose of epinephrine, the flush volume after intravascular epinephrine, and the duration of resuscitation with an absent heart rate. In addition, the program has enhanced components of the textbook to improve learning, added new course delivery options, and offers 2 course levels to allow learners to study the material that is most relevant to their role during neonatal resuscitation. This review summarizes the recent changes to the resuscitation guidelines, the textbook, and the Neonatal Resuscitation Program course.

The NRP 8th Edition: Innovation in Education

The American Academy of Pediatrics/American Heart Association Neonatal Resuscitation Program® (NRP®) 8th-Edition materials were released in June 2021 and must be in use by January 1, 2022. Ongoing international review and consensus of resuscitation science since 2015 has yielded no major changes in practice. However, the NRP Steering Committee revised several practices in the interest of patient safety and educational efficiency. The NRP 8th Edition offers NRP Essentials and NRP Advanced levels of learning and 2 recommended Provider Course formats. In most hospitals, NRP Essentials and NRP Advanced will be taught using instructor-led Provider Courses. Resuscitation Quality Improvement® (RQI® for NRP®), a self-directed learning program that uses low-dose, high-frequency quarterly learning and skills sessions, may be used in hospitals that already use RQI for life support education.

NRP 7th Edition: Are You Prepared?

The seventh edition of the American Academy of Pediatrics/American Heart Association Neonatal Resuscitation Program (NRP) materials must be in use by January 1, 2017. As in previous editions, changes in resuscitation science are based on an international review and consensus of current resuscitation science. The seventh edition NRP materials also include enhancements to training materials aimed at improving the quality of NRP instruction and providing the opportunity for ongoing education. A standardized approach to instructor training, an online Instructor Toolkit, eSim cases, and a new learning management system are among the new resources.

Self-directed versus traditional classroom training for neonatal resuscitation

OBJECTIVE

Neonatal Resuscitation Program instructors spend most of their classroom time giving lectures and demonstrating basic skills. We hypothesized that a self-directed education program could shift acquisition of these skills outside the classroom, shorten the duration of the class, and allow instructors to use their time to facilitate low-fidelity simulation and debriefing.

METHODS

Novice providers were randomly allocated to self-directed education or a traditional class. Self-directed participants received a textbook, instructional video, and portable equipment kit and attended a 90-minute simulation session with an instructor. The traditional class included 6 hours of lectures and instructor-directed skill stations. Outcome measures included resuscitation skill (megacode assessment score), content knowledge, participant satisfaction, and self-confidence.

RESULTS

Forty-six subjects completed the study. There was no significant difference between the study groups in either the megacode assessment score (23.8 [traditional] vs 24.5 [self-directed]; P = .46) or fraction that passed the "megacode" (final skills assessment) (56% [traditional] vs 65% [self-directed]; P = .76). There were no significant differences in content knowledge, course satisfaction, or postcourse self-confidence. Content knowledge, years of experience, and self-confidence did not predict resuscitation skill.

CONCLUSIONS

Self-directed education improves the educational efficiency of the neonatal resuscitation course by shifting the acquisition of cognitive and basic procedural skills outside of the classroom, which allows the instructor to add low-fidelity simulation and debriefing while significantly decreasing the duration of the course.

Prenatal Screening for Substance Use and Violence: Findings from Physician Focus Groups

OBJECTIVE

To guide quality improvement activities, the study sought to identify effective strategies for influencing and improving physician screening and referral of pregnant women for violence and substance abuse (alcohol, drugs and tobacco).

METHODS

This qualitative study conducted in Washington State consisted of interviews with eight physicians and focus groups with twenty-eight physicians who practice obstetric care. Physicians, selected using systematic sampling, were asked about perceptions on the importance of screening and barriers to effective screening, awareness of information and resources from the state Department of Health, and the effectiveness of various provider training strategies for improving prenatal screening.

RESULTS

Physicians were most interested in practical, concise information for themselves and office staff. Referral information and patient handouts were identified as important tools to increase the efficacy of screening and intervention. Physicians supported in-person programs in offices or in hospitals but rejected use of audio conferences and direct mailings.

CONCLUSIONS

This study provided insight about the way we deliver best practice information to physicians. Collecting qualitative data from physicians is important prior to developing statewide quality improvement activities aimed at this group.

NRP 2006: What you should know

In spring 2006, the American Academy of Pediatrics (AAP) and the American Heart Association (AHA) will introduce revised materials for the Neonatal Resuscitation Program (NRP). These revisions affect the practice of neonatal resuscitation as well as the administrative components of the NRP. This article cannot address every program revision. Instead, it summarizes what prompted the program changes and then introduces the reader to guideline revisions that affect practice, as well as to changes in NRP tools and resources. The fifth edition of the Textbook of Neonatal Resuscitation is currently in press. The AAP granted permission to use material from the forthcoming edition in this article.

NRP 2006: how revised guidelines develop

Revised materials for the Neonatal Resuscitation Program (NRP) will be released in spring 2006. These revisions are the result of a carefully synchronized process carried out by members of the International Liaison Committee on Resuscitation (ILCOR) Neonatal Delegation, which includes the American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee and the American Heart Association. ILCOR provides a consistent international framework for identifying and reviewing research on various aspects of resuscitation, a forum for debating issues and reaching consensus, and a mechanism for publishing findings in medical journals. NRP 2006 materials will be the result of carefully coordinated efforts and international collaboration on resuscitation science.

The history of neonatal resuscitation

Attempts at human resuscitation date back to ancient times. Most strategies for resuscitation focused on adults until the early 1800s, when newborn resuscitation captured the interest of noted practitioners. The most promising techniques and strategies for neonatal resuscitation were developed during the latter part of the twentieth century. This article examines the key components of neonatal resuscitation and the discoveries that stimulated the development of current neonatal resuscitation practices.

Neonatal resuscitation emergencies at birth: case reports, using NRP 2000 guidelines

In 2000, the American Academy of Pediatrics and the American Heart Association formulated new international evidence-based guidelines for neonatal resuscitation. Whereas the earlier Neonatal Resuscitation Program guidelines incorporated a hierarchical approach to resuscitation, the revised program bases interventions on simultaneous assessment of breathing, heart rate, and color. Resuscitation success builds on the concepts of resuscitation readiness, knowledge and skills, teamwork, and self-efficacy. Six case reports illustrate revised Neonatal Resuscitation Program guidelines for managing selected resuscitation emergencies of newborns.

Introduction to the revised Neonatal Resuscitation Program guidelines: questions and answers to get you started

In October, 2000, the American Academy of Pediatrics (AAP) and the American Heart Association (AHA) introduced revised guidelines for the Neonatal Resuscitation Program (NRP). These revisions affect the practice of neonatal resuscitation as well as the administrative components of the program. This article cannot address every program revision, but introduces the reader to how program changes occurred, guideline revisions that affect practice, and changes in NRP educational tools and resources.

The drug-exposed mother and infant: a regional center experience

Drug-exposed mothers and infants continue to challenge maternal and infant health care resources. The woman who abuses drugs may have a complex social history and high resistance to change. Drug use may be intergenerational and long-standing. Although cocaine may be a drug of choice, there is often polydrug abuse, complicating the assessment of the newborn who may be suffering from an overall unstable intrauterine environment due to poor general health and lack of nutrition, inadequate prenatal care, and risk of exposure to contaminants from street drugs and of infection, including Hepatitis B and HIV. Infants must be thoroughly assessed and treated as any newborn at risk. Drug screening and child welfare issues are discussed. Hepatitis B immunization is recommended. Ongoing assessment of the infant and intervention techniques are described. Since many drug-exposed infants go home with their mothers, an integrated plan of care for mother and infant may contribute to a therapeutic relationship, facilitate maternal attachment behaviors, and motivate maternal rehabilitation. For nurses caring for these demanding families, burnout prevention and self-care strategies are discussed.