Abstract

Purpose 	
To evaluate newborn life support (NLS) guideline adherence amongst Dutch paediatricians in a simulated setting, to assess their knowledge regarding NLS, and to offer strategies to improve guideline adherence. 

Materials and methods	
Paediatricians attending a continuing medical education event at our centre completed a 23-item multiple-choice questionnaire (MCQ) on NLS. Next, they participated in a simulated NLS scenario. Our model-driven, high-fidelity neonatal patient simulator provided quantitative feedback on airway patency, ventilations, compressions, time to epinephrine administration, and time to recovery. One researcher watched all videotaped simulations to assess adherence to other aspects of the NLS algorithm. A systematic literature search was performed to identify additional publications containing information on strategies to improve guideline adherence.     

Results
Forty-six paediatricians, working in 24 different hospitals, participated. Forty-five completed the MCQ, 34 participated in the scenario. Fifty-six percent performed inflation breaths within 60 sec, 24% delivered inflation breaths of 2-3 sec, and 85% used an adequate peak inspiratory pressure. Airway patency was ensured during 83% (IQR 76 – 92) of the available time. Median events/min, compression rate, and percentage of effective compressions were 138/min (IQR 130-145) (recommended 120/min), 120/min (IQR 114-120) (recommended 100-120/min), and 38% (IQR 24-48) (ideally 100%), respectively. Median time between initiation of compressions and first epinephrine dose, and median time to recovery were 269 sec (IQR 230-346) and 444 sec (IQR 388-565), respectively. Additional adherence percentages were: drying the newborn 94%, wet towel removal 53%, hat placement 68%, heart rate auscultation 100%, pulse oximetry use 94%, increase of oxygen concentration when initiating compressions 74%, and correct epinephrine dose 82%. A median of 70% (IQR 59-78) of the MCQ questions were answered correctly. Ten publications were found for our framework. 

Conclusion	
There is room for improvement  in NLS guideline adherence and knowledge amongst paediatricians. Our comprehensive framework may contribute to this improvement.

5 - Newborn life support guideline adherence: simulation study and framework for improvement