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Most newborn infants do well at birth; however, some require immediate attention by a team with advanced resuscitation skills. Providers at rural or community hospitals do not have as much opportunity for practice of their resuscitation skills as providers at larger centers and are, therefore, often unable to provide the high level of care needed in an emergency. Education through telemedicine can bring additional training opportunities to these rural sites in a low-resource model in order to better prepare them for advanced neonatal resuscitation. Telemedicine also offers the opportunity to immediately bring a more experienced team to newborns to provide support or even lead the resuscitation. Telemedicine can also be used to train and assist in the performance of emergent procedures occasionally required during a neonatal resuscitation including airway management, needle thoracentesis, and umbilical line placement. Telemedicine can provide unique opportunities to significantly increase the quality of neonatal resuscitation and stabilization in rural or community hospitals.

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Introduction Because improved competence in caring for patients is difficult to measure, self-efficacy (the strength of one's belief in one's ability to complete a task) is often used as a surrogate measurement of clinical ability. However, studies in adults and children have shown at best only weak correlations between self-efficacy and performance. This correlation has not been well studied in neonatal resuscitation limiting the utility of self-efficacy as a measurement of the effectiveness of interventions in this population. The objective of this study was to determine whether self-efficacy correlates with performance of simulated neonatal chest compressions and ventilation. Methods Sixty-nine neonatal fellows, neonatal nurse practitioners, neonatologists, and nurses completed a 7-point Likert scale in which they reported their ability to perform ventilations and chest compressions. The participants then performed chest compressions and bag-valve-mask ventilation on a mannequin. The performance of participants was compared with the rating of their ability using Spearman rank correlation coefficient. Results There was no correlation between participants' self-assessment and performance of chest compressions (r s = 0.003) or bag-valve-mask ventilation (r s = 0.08). There was a correlation between experience (years of neonatal intensive care unit experience, number of mock codes, and number of real codes) and the ratings of self-efficacy as well as between the number of mock codes and ventilation performance. Conclusions In this study, self-reported efficacy had no correlation to clinical skills in neonatal resuscitation; participants both overestimated and underestimated their clinical proficiency. Prior participation in mock codes in the neonatal intensive care unit was the only factor that correlated with resuscitation performance.

(1) Background: Timely and effective positive pressure ventilation (PPV) is the most important component of neonatal resuscitation. Emerging data supports the use of supraglottic airways such as the laryngeal mask airway (LMA) as a first-line interface for PPV during neonatal resuscitation. LMA use reduces the need for intubation compared to facemask use in systematic reviews, but there is no difference in the incidence of death or moderate-to-severe hypoxic ischemic encephalopathy (HIE). Time to effective ventilation during simulation with manikin models by providers with limited neonatal airway experience may add to the current evidence that compares the LMA to the neonatal facemask as the first-line ventilation interface during neonatal resuscitation.; (2) Methods: Thirty-two pre-clinical medical students were recruited and randomized to learning and performing ventilation with either the LMA or neonatal facemask on a neonatal manikin. Tidal volume was measured by breath-by-breath analysis to assess adequacy and consistency of PPV in 10 consecutive breaths. Perceived confidence was measured by pre- and post-intervention surveys that utilized a Likert scale from 1 to 5.; (3) Results: Median time to achieve effective ventilation was shorter with a neonatal facemask compared to the LMA (43 (30, 112) seconds vs. 82 (61, 264) seconds, p < 0.01). Participants reported higher perceived confidence post-intervention with use of a facemask when compared to use of the LMA (5 (4, 5) vs. 4 (4, 4), p = 0.03).; (4) Conclusions: Pre-clinical medical students demonstrated a shorter time to effective ventilation and reported higher confidence scores after learning and demonstrating PPV using the facemask when compared to LMA in a neonatal manikin. Further studies are warranted to evaluate the use of supraglottic airways in providers with limited experience with airway management of neonates, as well as in ways to better promote proficiency and confidence in the use of the LMA.