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ObjectiveDescribe the current practice of family presence during neonatal tracheal intubations (TIs) across neonatal intensive care units (NICUs) and examine the association with outcomes.DesignRetrospective analysis of TIs performed in NICUs participating in the National Emergency Airway Registry for Neonates (NEAR4NEOS).SettingThirteen academic NICUs.PatientsInfants undergoing TI between October 2014 and December 2017.Main outcome measuresAssociation of family presence with TI processes and outcomes including first attempt success (primary outcome), success within two attempts, adverse TI-associated events (TIAEs) and severe oxygen desaturation ≥20% from baseline.ResultsOf the 2570 TIs, 242 (9.4%) had family presence, which varied by site (median 3.6%, range 0%–33%; pConclusionFamily are present in less than 10% of TIs, with variation across NICUs. Even after controlling for important patient, provider and site factors, there were no significant associations between family presence and intubation success, adverse TIAEs or severe oxygen desaturation.

We aimed to measure provider perspectives on the acceptability, appropriateness, and feasibility of teleneonatology in neonatal intensive care units (NICUs) and community hospitals. Providers from five academic tertiary NICUs and 27 community hospitals were surveyed using validated implementation measures to assess the acceptability, appropriateness, and feasibility of teleneonatology. For each of the 12 statements, scale values ranged from 1 to 5 (1 = strongly disagree; 5 = strongly agree), with higher scores indicating greater positive perceptions. Survey results were summarized, and differences across respondents assessed using generalized linear models. The survey response rate was 56% (203/365). Respondents found teleneonatology to be acceptable, appropriate, and feasible. The percent of respondents who agreed with each of the twelve statements ranged from 88.6 to 99.0%, with mean scores of 4.4 to 4.7 and median scores of 4.0 to 5.0. There was no difference in the acceptability, appropriateness, and feasibility of teleneonatology when analyzed by professional role, years of experience in neonatal care, or years of teleneonatology experience. Respondents from Level I well newborn nurseries had greater positive perceptions of teleneonatology than those from Level II special care nurseries. Providers in tertiary NICUs and community hospitals perceive teleneonatology to be highly acceptable, appropriate, and feasible for their practices. The wide acceptance by providers of all roles and levels of experience likely demonstrates a broad receptiveness to telemedicine as a tool to deliver neonatal care, particularly in rural communities where specialists are unavailable.· Neonatal care providers perceive teleneonatology to be highly acceptable, appropriate, and feasible.. · Perceptions of teleneonatology do not differ based on professional role or years of experience.. · Perceptions of teleneonatology are especially high in smaller hospitals with well newborn nurseries..

Neonatologists provide counseling to expectant parents to prepare them for the birth and subsequent medical care that their extremely preterm, or otherwise medically complex newborn may require. The skills required to conduct these sensitive conversations are often taught to neonatology trainees via direct observation or simulated scenarios in advance of counseling actual patients. This technical report details how we taught antenatal counseling skills to junior neonatal-perinatal medicine (NPM) fellows via video conferencing during the coronavirus disease 2019 (COVID-19) pandemic. This approach could be used to effectively prepare future trainees to perform antenatal counseling.

Background: Each year, there are 2.8 million newborn deaths, most of which are preventable. Intrapartum asphyxia is one of the three leading causes of neonatal mortality. In 2017, poor quality of care accounted for almost 1 million neonatal deaths, mostly during the intrapartum period. As the majority of these deaths occur in low- and middle-income country settings where there is high penetrance of mobile devices, we hypothesized that mobile virtual reality (VR) simulation refresher training in neonatal resuscitation (NR) would support the maintenance of HCW NR skills …

Objective Determine the feasibility, strengths, and barriers of offering extracorporeal membrane oxygenation (ECMO) telerounding to neonatal intensive care unit (NICU) care providers. Study design NICU providers were invited to join ECMO rounds by teleconference. Data were collected on telerounding participation and ECMO concepts discussed. A survey was sent to all providers. Results From March 2018 to February 2020, telerounding on 24 neonatal ECMO patients (168 ECMO days) was performed in a Level IV NICU. A mean of four providers joined telerounds per ECMO day with an increase from 3 to 6 providers over the study period. Nearly all respondents felt telerounding lowered barriers to attending ECMO rounds (94%), promoted engagement (89%), and improved continuity of care (78%). Barriers to ECMO telerounding were suboptimal audio connections and limited ability to participate in the clinical discussion. Conclusion ECMO telerounding is well-received by NICU providers. It can improve provider participation, complement existing in-person ECMO rounds, and ECMO education.

BACKGROUND:Neonatal-perinatal medicine (NPM) fellowship programs must provide adequate delivery room (DR) experience to ensure that physicians can independently provide neonatal resuscitation to very low birth weight (VLBW) infants. The availability of learning opportunities is unknown.METHODS:The number of VLBW (≤1500 g) and extremely low birth weight (ELBW) (RESULTS:Of the 94 NPM fellowships, 86 programs with 115 delivery hospitals and 62 699 VLBW deliveries (28 703 ELBW) were included. During a 3-year fellowship, the mean number of deliveries per fellow ranged from 14 to 214 (median: 60) for VLBWs and 7 to 107 (median: 27) for ELBWs. One-half of fellows were expected to see ≤23 ELBW deliveries and 52 VLBW deliveries, 24 instances of continuous positive airway pressure, 23 intubations, 2 instances of chest compressions, and 1 treatment with epinephrine.CONCLUSIONS:The number of opportunities available to fellows for managing VLBW and ELBW infants in the DR is highly variable among programs. Fellows’ exposure to key, high-risk DR procedures such as cardiopulmonary resuscitation is low at all programs. Fellowship programs should track fellow exposure to neonatal resuscitations in the DR and integrate supplemental learning opportunities. Given the low numbers, the number of new and existing NPM programs should be considered.

ObjectivesThe objective of this study was to explore the access to, and perceived utility of, various simulation modalities by in-service healthcare providers in a resource-scarce setting.SettingPaediatric training workshops at a national paediatric conference in Nigeria.ParticipantsAll 200 healthcare workers who attended the workshop sessions were eligible to participate. A total of 161 surveys were completed (response rate 81%).Primary and secondary outcome measuresA paper-based 25-item cross-sectional survey on simulation-based training (SBT) was administered to a convenience sample of healthcare workers from secondary and tertiary healthcare facilities.ResultsRespondents were mostly 31–40 years of age (79, 49%) and women (127, 79%). Consultant physicians (26, 16%) and nurses (56, 35%) were in both general (98, 61%) and subspecialty (56, 35%) practice. Most had 5–10 years of experience (62, 37%) in a tertiary care setting (72, 43%). Exposure to SBT varied by profession with physicians more likely to be exposed to manikin-based (29, 30% physicians vs 12, 19% nurses, pConclusionsThe access of healthcare workers to SBT is limited in resource-scarce settings. While acknowledging the challenges, respondents identified many areas in which SBT may be useful, including skills acquisition, skills practice and communication training. Healthcare workers were open to the use of online SBT and expressed the need to expand SBT beyond the current scope for health professional training in Nigeria.

To examine the use and perceived safety of stylets for neonatal intubation in a cohort of providers in the United States. A cross-sectional survey was sent to members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine. A total of 640 responses were received. 57% reported using a stylet ‘every time’ or ‘almost every time’ they intubated. The preferred stylet bend was a smooth bend of

Educators need accessible learner-centered tools to prepare health professional learners for safe interprofessional practice. TeamSTEPPS ® is an evidence-based teamwork training program. Virtual TeamSTEPPS ® scenarios were developed to overcome some of the barriers to interprofessional learning, including space and scheduling. However, teamwork attitudes may vary at baseline among health professional students and in response to virtual teamwork training. Three 5-min virtual TeamSTEPPS ® scenarios were used by health professional students in the nursing, occupational therapy and physician assistant programs at two Midwestern universities. The scenarios required learners to use or identify teamwork strategies as part of an interprofessional team. The assessment and evaluation compared teamwork attitudes at baseline, and following use of teamwork training scenarios, using a validated tool, the TeamSTEPPS ® Teamwork Attitudes Questionnaire. Of 319 learners with matched pre-post teamwork attitude scores, 57.4% were from the Nursing program, female (85.5%) and aged 18–24 years (78.1%). There were no differences in pre-intervention teamwork attitudes except Mutual Support (p

Nasal-tragus length (NTL) estimates of endotracheal tube (ETT) depth are replacing weight-based estimates for endotracheal tube depth in neonates requiring endotracheal intubation. Existing neonatal simulators were designed before interest in using the NTL, and may lack fidelity in this measurement. The objective of this study is to evaluate the accuracy of the adjusted NTL formula and the Neonatal Resuscitation Program (NRP) gestational age/weight-based ETT depth chart in predicting proper endotracheal tube insertion depth in a cohort of neonatal simulators. The NTL and appropriate intubation depth to the mid-trachea were measured for 11 commonly used neonatal intubation simulators. The NTL+1 cm formula incorrectly estimates the mid-tracheal depth in 82% of simulators, and the weight-based chart incorrectly estimates depth in 75% of test simulators. Only one simulator experienced a mainstem intubation with ETT insertion to the depth predicted by the NTL+1 cm formula. The majority of neonatal resuscitation simulations lacked physical fidelity with regard to mid-tracheal ETT insertion depth. The NRP gestational age/weight-based chart outperformed the NTL+1 cm formula but still resulted in endotracheal tube misplacement in the majority of neonatal simulators. The majority of simulators had adequate functional fidelity using either method for ETT depth estimation.

To determine 1-year survival in a cohort of newborns with an Apgar score of 0 at 5 and 10 min of age. A retrospective cohort study of the Washington State Comprehensive Hospital Abstract Reporting System from 2005 to 2014. Of 879,340 births, 199 (0.02%) had an Apgar score of 0 at 5 min, and 109 (0.01%) also had a score of 0 at 10 min. One-year survival was 46% for newborns with Apgar score of 0 at 5 and 10 min. One-year survival by gestational age was 4% for newborns

Neonatologists must be skilled at providing antenatal counseling to expectant parents of premature infants at the limits of viability. We conducted a medical improvisation workshop with the objective of enhancing antenatal counseling skills.Pre- and postworkshop questionnaires were collected to examine the impact of the training. A follow-up survey was distributed 3 months after the workshop to examine the impact of the training on antenatal counseling skills.Nine neonatologists and three neonatal fellows participated in the workshop. Participants reported the skills learned in the workshop could enhance the quality of antenatal counseling. On follow-up survey, 90% of subjects reported improvements in the quality of their antenatal counseling.Participation in a medical improvisation workshop resulted in enhancements of self-perceived antenatal counseling skills. Medical improvisation training may provide a feasible and effective method of communication training for neonatologists. Further research into this innovative method are needed.

Global health experiences evoke a profound awareness of cultural differences, inspire learners to prioritize professional values, and provide a lens for addressing global health care challenges. This study compares the long-term career and practice choices of participants in a 2-month Indiana University-Moi University, Kenya elective from 1989-2013 with those of a control group.Global health elective (GHE) participants and a random sample of alumni without GHE experience were surveyed on their clinical practice, public health and global health activities.Responses from 176 former participants were compared with a control group of 177 alumni. GHE participants were more likely than similar controls to provide care to underserved U.S. populations (p=0.037), spend time in global health, public health, and public policy activities (p=0.005) and be involved in global health advocacy (p=0.001). Using multivariable analysis, GHE participants were more likely to be generalists (p0.05), report that healthcare costs influenced medical decision-making (p0.05), and provide healthcare outside the U.S. for ≥1 week/year (p0.001).Many years out of training, GHE participants were more likely to be generalists working with underserved populations, to be cost-conscious in their healthcare decision-making, and to be involved in global health, public health or public policy.With the primary care provider shortage and need for greater awareness among providers of healthcare costs, our study shows that that global health experiences may yield broader benefits to the U.S. medical system.

To compare job search experience and postresidency position of pediatric residents on the basis of childhood location (United States or international) and medical school location (American medical graduates [AMG] or international medical graduate [IMG]).Annual national random samples of 1000 graduating pediatric residents from 2009 to 2013 were surveyed. Multivariable analyses, controlling for resident and program characteristics, compared job search experiences and postresidency positions among 4 groups categorized by childhood and medical school location: US-AMG, US-IMG, international-AMG, and international-IMG.A total of 3027 graduating residents (61.1%) responded: 75.2% US-AMG, 15.8% international-IMG, 6.3% US-IMG, and 2.7% international-AMG. The 4 groups varied by demographics (age, race, gender, marital status, children, bi- or multilingual family), educational debt, residency program region and size, and Spanish proficiency (P .01). The US-AMG were least likely to have a bi- or multilingual family (25.7%) or be proficient in Spanish (15.0%). One-third (34.5%) accepted fellowship positions. International-IMG and US-IMG were more likely than US-AMG to choose fellowship positions (adjusted odds ratio [aOR], 2.04; 95% confidence interval [CI], 1.52-2.74; aOR, 1.77; 95% CI, 1.25-2.52, respectively). Among residents who applied for general pediatric or hospitalist positions, 23.1% reported moderate to considerable difficulty in their job search, and 44.1% accepted positions in underserved areas. International-IMG and US-IMG were more likely than US-AMG to report job search difficulty (aOR, 2.49; 95% CI, 1.55-3.98; aOR, 1.78; 95% CI, 1.04-3.06, respectively), and international-IMG were more likely to accept positions in underserved areas (aOR, 1.68; 95% CI, 1.07-2.63).Multiple factors are involved in pediatrician's career choices. When childhood location is considered with medical school location, there were differences between groups in demographics, job search difficulty, and career intentions.

Objective To explore care experiences of women who used prescription or illicit opioids and experienced fetal or infant loss. Design A qualitative, descriptive design with secondary data analysis. Setting The Fetal and Infant Mortality Review program in an urban Midwestern county in the United States. Participants Eleven women with histories of prescription or illicit opioid use who experienced fetal or infant loss participated in the semistructured telephone or in-person interview portion of the mortality case review. Methods We used thematic analysis to analyze interview data. Results Five themes were identified related to the care experiences of participants throughout pregnancy and fetal/infant loss: Frustration and anger related to not being heard, feeling minimalized ; Being overwhelmed with attempts to process and understand medical complications and outcomes ; Profound sense of grief and coping with loss ; Need to understand why and make difficult decisions ; and Placing blame and guilt over death . Conclusion Our findings suggest that women who use opioids and experience fetal or infant loss have complex care, educational, and emotional needs. In the development of interventions for these women, it is important to address their unique and complex circumstances.

Little is known about the association between mentorship and career choice during residency in pediatrics. This study examines graduating residents with mentors who provide career advice and the relationship between having a mentor who is a subspecialist and having a subspecialty practice goal.National, random samples of 1000 graduating pediatrics residents were surveyed each year from 2006 to 2012; 4197 (61%) responded. Responses were pooled across years to examine mentor specialty and career goal at time of residency graduation. Multivariable logistic regression was used to examine relationships between mentor specialty and career goal at the time of graduation.Most (87%) residents reported having a mentor who provided career advice during residency; the proportion linearly increased from 83% in 2006 to 87% in 2012; P.05. Forty-five percent of those with mentors had a mentor who was a subspecialist; 55% had a generalist as a mentor. Overall, 45% of residents had a subspecialty career goal at time of graduation. After controlling for career goal at the start of residency and resident characteristics, residents with a subspecialist mentor were more likely to have a subspecialty career goal at time of graduation (adjusted odds ratio = 5.25; 95% confidence interval, 4.41-6.25). Residents who were male, without children, without debt, not married, not minority, and from larger residency programs were also more likely to have a subspecialty career goal at the time of graduation from residency.Almost 9 in 10 pediatric residents have a mentor who provides career advice. Although multiple factors shape decisions about careers, mentor specialty is one factor that might encourage residents to pursue fellowship training.

BackgroundGlobal health programs that allow international experiences for US learners should also enable reciprocal learning experiences for international learners, particularly if that is a need identified by the partner institution.MethodsA partnership between Indiana University and Moi University, Kenya, has successfully hosted 41 visiting Kenyan internal medicine and pediatrics registrars at Indiana University since 2006. The program's logistics, curriculum, and evaluation are described.ResultsThe registrars rotated through nephrology, cardiology, hematology and oncology, infectious diseases, and intensive care, as well as related ambulatory experiences, functioning on a level comparable to fourth-year medical students. They showed significant improvement in pretest and posttest scores on a standardized National Board of Medical Examiners examination (P = .048). International learners experienced culture shock, yet they felt the Indiana University elective was helpful and would recommend it to future participants.ConclusionsGlobal health programs can reciprocate the benefits derived for US students and residents by offering learning experiences to international learners if that is an expressed need from the international partner. Barriers to those experiences can be overcome, and the hands-on, elective experience has the potential to positively affect the knowledge and attitudes of participants as well as the home nation.

Background Acute bronchiolitis is a common respiratory infection and a major cause of morbidity in young children. It is treated with bronchodilators (for example, salbutamol), corticosteroids or humidified air (steam inhalation or cool mist). Steam inhalation is preferred in low-income countries as it is inexpensive and easily available. It is thought to act as a secretolytic agent to lighten secretions in the respiratory tract and relieve respiratory distress. Objectives To evaluate the effect of steam inhalation or humidified oxygen to relieve respiratory distress and to evaluate adverse events in children up to three years old with acute bronchiolitis. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 1) which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1950 to February Week 4, 2010), EMBASE.com (1974 to March 2010), CINAHL (1981 to March 2010), AMED (1985 to March 2010), Web of Science (2000 to March 2010) and LILACS (1982 to March 2010). Selection criteria Randomised controlled trials involving children up to three years old with bronchiolitis comparing steam inhalation (or cool mist) or humidified oxygen against bronchodilators, corticosteroids or placebo; alone or in combination. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Main results Only one study (156 children aged between seven weeks and 24 months with signs and symptoms of bronchiolitis) met the eligibility criteria for inclusion. Participants were randomised into three groups: nebulised salbutamol, nebulised saline and mist in a tent. The results showed a significant decrease in respiratory distress symptom (RDS) score in the nebulised salbutamol group but no significant decrease in the RDS score in the mist in a tent or nebulised saline groups. The study did not report on adverse effects of the interventions. Authors' conclusions Steam inhalation (or cool mist therapy) is commonly used to treat acute bronchiolitis in resource-constrained settings. One study was eligible for inclusion and found that nebulised salbutamol was an effective intervention for young children with bronchiolitis but mist in a tent did not lead to a significant decrease in RDS score. Since only one study was analysed it would be misleading to conclude that mist therapy is ineffective in children with bronchiolitis. We conclude that there is insufficient evidence to inform practice regarding using steam inhalation or mist therapy for acute bronchiolitis in children up to three years old.