Can parental simulation improve neonatal CPR performance? A pilot study

Feasibility of Implementing Resuscitation Training for Parents of At-risk Infants at Discharge (FIRST AID)

INTRODUCTION

Neonatal intensive care unit (NICU) graduates are at risk of sudden death at home after discharge. Many of these deaths can be prevented if parents can identify warning signs and provide immediate resuscitation.

OBJECTIVES

The primary objective of this study was to assess the feasibility of training parents of high-risk neonates in low- and middle-income countries (LMICs) to deliver infant resuscitation effectively. The secondary objectives were to assess the parental anxiety and need for resuscitation at the end of one month after discharge.

METHODS

This prospective study was conducted in a tertiary care teaching hospital. After consent, parents of infants <34 weeks gestation, weighing < 1500 grams at birth, or with neurological abnormalities at discharge were trained in a modified version of basic newborn resuscitation using a low-fidelity mannequin and self-inflating bag by a trained neonatal fellow. Resuscitation skills were evaluated using a post-training assessment score sheet. A total score of 75% with four mandatory steps was considered pass; the parent was re-trained until they passed the evaluation. Anxiety levels of the parent were assessed one month after discharge using the General Anxiety Disorder 7 (GAD 7) scale, and the need for resuscitation was documented.

RESULTS

Between June 2020 to July 2021, a total of 91 parents of high-risk newborns were trained in infant resuscitation. The mean gestational age and birth weight of neonates were 30 (2) weeks and 1315 (349) grams, respectively. 80% of the trained parents passed on the first attempt, and 18% passed on the second attempt. The mean (SD) time required to train each parent was 22 (4) minutes. One-month post-discharge, one mother reported mild anxiety, and skills were used to resuscitate one infant.

CONCLUSION

Parents of high-risk neonates at LMICs can be trained to deliver effective cardiopulmonary resuscitation before discharge using low-fidelity simulators without increasing parental anxiety.

Basic Life Support Guidance for Caregivers of NICU Graduates: Evaluation of Skill Transfer after Training

Background Intensivists indeed discharge neonatal intensive care unit (NICU) graduates after a period of physiological stability. There is, however, a real risk of life-threatening events at home. Survival after such episodes depends on time from arrest to initiation of basic life support (BLS). It is rational to train parents who would be first responders. We sought to measure objectively and prospectively, effect of BLS training on parents of NICU graduates on the psychomotor, cognitive, and affective domains of human learning.

Methods After face-to-face training sessions, proportion of home caregivers who obtained 100% marks on a pretested performance checklist for psychomotor skills of BLS on a mannequin were measured. Two other domains of learning and number of attempts required to obtain desirable results were also analyzed.

Results Median (interquartile range [IQR]) birth weight of the high-risk neonates was 1,050 g (930, 1570) and median gestational age was 29 (IQR 28, 33) weeks. More than 75% of parents had no prior exposure to BLS training. Among 46 trained caregivers, 80.4% achieved the desired score of 5 in the psychomotor performance checklist on the first attempt. A maximum of two attempts was required to reeducate and achieve score of 5 in the remaining caregivers. Forty-two (91.3%) caregivers obtained full marks on cognitive domain test. All caregivers responded positively toward affective domain questionnaire.

Conclusion It is possible to train parents in BLS measures and demonstrate their psychomotor skills on a mannequin effectively. No parents who were approached refused training or indicated anxiety in learning the skills required.