400 - Assessment in Adherence to Neonatal Resuscitation Program (NRP) using Video Recording

Publication Number: 400.3729

Mananya Sukthong, Faculty of Medicine Ramathibodi Hospital, Mueang, Phitsanulok, Thailand; Pracha Nuntnarumit, Faculty of Medicine Ramathibodi Hospital, Bangkok, Krung Thep, Thailand; Pharuhad Pongmee, Mahidol University, Krung Thep, Krung Thep, Thailand

Background: Despite the availability of evidence-based guidelines, variations in adherence to neonatal resuscitation (NR) algorithm persist across different healthcare settings.

Objective: This study aimed to evaluate NR algorithm adherence for high-risk neonates among pediatric residents and improvement of performance following feedback interventions.

Design/Methods: An observational study was conducted at Ramathibodi Hospital, a university medical center in Thailand. Video-recorded resuscitations of high-risk neonates born between March 2023 and February 2024 were evaluated. Feedback interventions, including group feedback and experience-sharing sessions, were performed twice during the observation period.

Results: A total of 498 resuscitations were assessed, showing adherence rates ranging from 44.2% to 92% for each domain of NRs. Positioning exhibited the highest adherence (92%), while stimulation, positive pressure ventilation (PPV), and intubation had the lowest adherence rates, at 44.2%, 52.3%, and 66.7%, respectively. For preterm neonates with a gestational age ≤32 weeks, adherence to heat loss prevention was only 40.8% (Figure 1). The success rate of intubation was 50%, with first-attempt success observed in merely 41.2% of cases with an average duration of 39.7 (±18.7) seconds. After the interventions, improvement was noted in suctioning (92.3%, p< 0.001), stimulation (61.5%, p< 0.001), continuous positive airway pressure (CPAP) administration (89.7%, p=0.256), and intubation (100%, p=0.272) (Figure 2).

Conclusion(s): A significant number of deviations from the neonatal resuscitation algorithm were identified, particularly in heat loss prevention for preterm infants, suctioning, stimulation, CPAP, PPV, and intubation. Feedback interventions showed enhancements in specific domains, suggesting a need for additional models for further improvement.

Figure 1 Adherence to NRP algorithm
CPAP continuous positive airway pressure, GA gestational age, PPV positive pressure ventilation

Figure 2 Adherence to NRP algorithm before and after feedback intervention
CPAP continuous positive airway pressure, PPV positive pressure ventilation