Objective: To add a team training and human error curriculum to the Neonatal Resuscitation Program (NRP) and measure its effect on teamwork. We hypothesized that teams that received the new course would exhibit more teamwork behaviors than those in the standard NRP course.Study design: Interns were randomized to receive NRP with team training or standard NRP, then video recorded when they performed simulated resuscitations at the end of the day-long course. Outcomes were assessed by observers blinded to study arm allocation and included the frequency or duration of six team behaviors: inquiry, information sharing, assertion, evaluation of plans, workload management and vigilance. IntroductionThe Neonatal Resuscitation Program (NRP) is the standard curriculum used to teach caregivers how to treat newborns in the delivery room. Worldwide, the NRP could improve outcomes of thousands of newborns per year. 1 However, approximately 30% of NRP steps are not performed or performed incorrectly, 2,3 and pediatric residents often fail to intubate infants correctly. 4 Neonatal resuscitation should be a team activity that involves at least two people who work together to achieve a shared goal. 5 Breakdowns in teamwork may contribute to the quality problems noted above. For example, team behaviors are correlated with the quality of neonatal resuscitation, 3 communication breakdowns are root cause of 72% of perinatal deaths and injuries, 6 perceptions of effective teamwork are correlated with less burnout and fewer delays in labor and delivery, 7 and there is broad consensus from expert groups and researchers that measuring and improving teamwork will help improve the quality of health care. [8][9][10] However, none of the nine lessons in the NRP textbook 1 includes instruction about teamwork, in part because no studies have shown that team training can improve either teamwork or the quality of health care. 11,12 Therefore, we conducted a study with two specific aims: (1) to incorporate teamwork skills and information about human error into the 1-day NRP training program for interns and (2) to randomize interns to this new version of NRP or the standard NRP and measure the effects on teamwork during the simulated resuscitations at the end of the day. We hypothesized that it would be feasible to add the teamwork training to the 1-day NRP course, and that interns who were randomized to the NRP course with team training would exhibit more teamwork behaviors during the simulated resuscitation than would the interns in the standard NRP course.

Trained participants exhibited more frequent teamwork behaviors (especially the HFT group) and better workload management and completed the resuscitation more quickly than did control subjects. The impact on team behaviors persisted for at least 6 months. Incorporating team training into the NRP curriculum is a feasible and effective way to teach interns teamwork skills. It also improves simulated resuscitation quality by shortening the duration.

Twelve chronically instrumented late-gestation ewes fasted for 5 days were found to have a 25% decrease in total uterine blood flow and a 20% decrease in placental blood flow. Cardiac output was unchanged but was redistributed, as measured by radiolabeled microspheres, in a pattern similar to that produced by catecholamines. Fasting also was associated with hypoglycemia and altered whole blood amino acid concentrations. Uterine uptakes of glucose, oxygen, essential amino acids and glutamine, an important uterine and fetal nutrient, were decreased significantly during fasting. The increased hepatic blood flow and decreased arterial concentrations of glucogenic amino acids observed during fasting are consistent with a redistribution of maternal cardiac output to support maternal hepatic gluconeogenesis at the expense of nutrient supply to the gravid uterus.