CHOOSING ANTIBIOTICS WISELY IN NEONATES

The Center for Disease Control and Prevention (CDC) and the Vermont Oxford Network (VON) have decided to partner together to improve patient safety and raise the quality or neonatal care.1 Core elements for antimicrobial stewardship have been developed by the CDC, and the VON will incorporate these elements into their new quality improvement collaborative iNICQ 2016: Choosing Antibiotics Wisely.*

The focus of the collaborative will include improved communications, increased monitoring of infections, antibiotic use, as well as best practice for the prevention of infections. Appropriate prescription, dose, and duration will be established. Teams will work with VON leadership and expert faculty using the Choosing Antibiotics Wisely toolkit. There will be a quality Improvement Summit that will allow teams to share what they have learned and accomplished with the neonatal community.1

NEONATAL AIRWAY SIMULATORS: WHAT TO BUY?

Physical and functional fidelity is an important characteristic of neonatal simulators to improve airway management skills. Until recently, no studies have evaluated the fidelity of these simulators. A research project evaluated 8 different simulators, and significant differences were found between the simulators. The simulators evaluated were as follows: (1) SimNewB; (2) Newborn Ann; (3) Premature Anne; (4) Neonatal Intubation Trainer; (5) Newborn HAL; (6) Premie Blue; (7) air Sim Baby; and (8) Newborn Airway Trainer. Twenty-seven neonatal healthcare providers were part of the panel that evaluated the simulators; 12 of these providers were neonatal nurse practitioners (44%). There were 2 testing sessions, with 8 separate airways skill stations. Each station was complete with a simulator and appropriate equipment needed such as Miller blades #0 and #1, endotracheal tube, stylets, face masks, laryngoscope handle, and laryngeal mask airway (LMA). Each group rotated to all 8 stations in a predetermined order. The skills performed at each station included bag mask ventilation, LMA placement, and endotracheal intubation. Each skill was performed on the simulator.1

The SimNewB and the Newborn Anne scored the highest overall physical fidelity scores for full-term newborns, whereas the Premature Anne scored the highest for the preterm neonatal manikin. Significant differences were found in the face, mouth, gum tongue epiglottis, vocal cords, and airway tissue. The Newborn Airway Trainer was the highest overall physical fidelity task trainer. The highest functional fidelity simulator for mask ventilation and intubation was Premature Anne; for LMA training was Newborn Anne and SimNewB; and for airway management training was SimNewB. Premature Anne had the highest overall functional fidelity score.1

Results of this study may help the industry develop new airway devices for simulation. These results may also provide educators some guidance in choosing the simulator that would work best for their institution.

1. Sawyer T, Stradnjord TP, Johnson K, Low D. Neonatal airway simulators, how good are they? A comparative study of physical and functional fidelity. J Perinatol. 2016;36:151-156. [Context Link]

NEONATAL RESUSCITATION AND HELPING BABIES BREATHE GLOBAL IMPORTANCE

A global initiative between Neonatal Resuscitation Program (NRP) and Helping Babies Breathe (HBB) from the World Health Organization (WHO) provides complementary ways to decrease infant mortality in low- and middle-income countries.

NRP was developed in the 1970s and launched in 1987 as a response to the rate of neonatal mortality and the need to recognize and provide initial management of infants to first-level hospitals. NRP standardized the approach to all infants at the time of delivery based on best evidence currently available. The late 1980s was the first time NRP was taught outside North America. Other countries' healthcare systems facing similar challenges petitioned the American Academy of Pediatrics (AAP) in the early 1990s to begin train-the-trainer courses. These courses were all instituted in developing countries where health systems were refining mother and newborn care. Studies indicated improvement in provider knowledge, skill set, and performance. Recognition of a newborn needing resuscitation was improved. NRP initiatives achieved reduction in perinatal and neonatal mortality in many regions of the world.1

Twenty years after its inauguration, global neonatal mortality still needed to be addressed. The first 28 days of life accounts for 40% of deaths for children younger than 5 years. Ninety-eight percent of these deaths occur in low- and middle-income countries, with 75% occurring in the first week of life and 50% occurring on the first day. In countries with the highest mortality, 60% of births occur outside the hospital.2 New approaches were need and the AAP in 2006 developed the Global Implemental Task Force to address infant mortality outside the hospital. HBB was released by the WHO in 2010 with the goal of increased commitment and resources for resuscitation as essential newborn care. It was decided that basic resuscitation steps would be advantageous for most infants. Developing a transportable package that emphasizes learning and owned by the individual was their vision. There needed to be a change in thinking that infant death was inevitable. A graphic action plan with a pictorial algorithm instead of a written algorithm was developed with the goal of empowering the learner to acquirer knowledge and skill set. The Golden Minute was developed, which stressed that every infant should be either breathing or receiving ventilation by 1 minute after birth.

Train-the-trainer workshops started globally and have reached 73 countries. Both NRP and HBB offer simplicity and clarity in neonatal resuscitation but at different levels. First-level facilities educate and train on basic skills that can be utilized in or out of healthcare facilities. HBB flows directly into NRP if needed. Higher-level facilities such as district hospitals receive NRP training to care for sick and premature infants.1 The effectiveness of this program highlights the importance of training with follow-up practice. Mastery of advance skills did require further classes. A reduction in infant mortality on day of life 1 has been demonstrated with changes in the clinical management of infants with HBB training. Skilled providers at every delivery in or out of the hospital setting have the ultimate goal of decreasing infant mortality.

Working together, NRP and HBB can strive to meet the Every Nation Action Plan goal of decreasing infant mortality to fewer than 10 per 1000 live births by 2035.

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