Background

Heart rate (HR) measurement is critical in guiding early interventions in neonatal resuscitation. Conventional methods for HR assessment rely on auscultation and use of pulse oximeter (POX) for pulse rate (PR). Recent guidelines recommend the use of the electrocardiogram (ECG) in HR assessment during resuscitation, however there have been barriers to implementation including clinical feasibility and potential risk to the newborn.

Objectives

The aim of the study was to assess the feasibility of ECG with POX by comparing time to application of ECG electrodes vs POX sensors; time to first reliable HR/PR; and agreement of POX against ECG.

Methods

A cross sectional study. All pre-term and term deliveries from October 2018 to March 2019 were included. At delivery, neonates had both ECG/POX sensors applied from the time the neonate was put under the radiant warmer with continuous monitoring of HR/PR for 10 minutes or until transfer. Reporting of adverse side effects was monitored. Data was compared using a Mann-Whitney U test and agreement analysed using a Bland-Altman plot.

Results

Based on data collected so far (n=28), time to apply ECG [median= 25s(21,34)] vs POX [median = 37s(27.5, 42.25)] was significantly different (p=0.004). Time to display a reliable HR [median= 6.5s(5,15.25)] was also significantly different from POX [median= 65s(32,100.5)] (p=0.000). Bland-Altmann Plot showed reasonable agreement [mean= 7.57bpm(-33.92,49.06)].

Conclusion

ECG provided faster and more accurate display of HR during resuscitation, providing clinicians with a more reliable assessment of HR.

Background

The Singapore Neonatal Resuscitation Course (SNRC) curriculum is comprised of online e-learning modules, and 1-day instructor facilitated performance and integrated skills training, simulation and debriefing. Current institutional policies require local healthcare professionals to undergo training once every 2 years. However, evidence suggests that knowledge and skills in neonatal resuscitation decay with time as early as 6 months post-training.

SNRC in collaboration with Serious Games Association, Singapore (SGA) designed and developed a computer-simulated neonatal resuscitation assessment game.

Objectives

To develop and implement an unguided, web-based simulation game for re-training and assessment of knowledge and technical skills in neonatal resuscitation.

Methods

A single-player, unguided, time-constrained web-based simulation game was built. The player is the team leader, with 1-3 non-player characters (NPC) in a scenario-based neonatal resuscitation. To promote situated learning, the 2015 newborn resuscitation algorithm was formalized. Learning content is embodied within the game design by recreating accurate simulation environment, including gameplay features and teaching strategies.

Results

Resuscitation scenarios under 3 main categories (Term, Preterm, Extreme Preterm) with graduated levels of difficulties (Easy, Moderate, Challenging) were developed. At the end of every game session, a detailed feedback is available to the user for self-assessment and monitor user’s progress. User's performance data are stored for program evaluation.

Conclusion

Neonatal Resuscitation Training Game (link: https://youtu.be/0aDzjJTWUsc) is a model of learning that facilitates learning on a continuous basis with a focus on competency rather than compliance to institutional policy. It empower learners to take control of their own education and has the potential to impact re-training and competency maintenance in other resuscitation programmes.