Journal of Neonatal-Perinatal Medicine - Volume 12, issue 2

Authors: Volpe, Joseph J.

Article Type: Editorial

Keywords: Neonatal encephalopathy, placenta, fetal vascular malperfusion, hypoxia-ischemia

DOI: 10.3233/NPM-190270

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 2, pp. 113-116, 2019

Authors: Sehgal, A. | Linduska, N. | Huynh, C.

Article Type: Research Article

Abstract: BACKGROUND: Hypoxic ischemic encephalopathy (HIE) affects  one to two newborns per 1,000 live births and oftentimes involves multi-organ insult. The objectives were to assess the evolution of cardiac function in infants with HIE treated with therapeutic hypothermia using echocardiography (ECHO). METHODS: Archived data during the period 2010-2016 was assessed. Amongst the infants with baseline ECHO assessments, a sub-cohort which had assessments in all the three phases (baseline/pre-active cooling [T1], cooling [T2] and rewarming [T3]) was analyzed separately. RESULTS: Thirty three infants formed part of the overall cohort, the gestation and birthweight were 39.6 ± 1.6 weeks …and 3306 ± 583 g, respectively. Baseline (T1) information noted impaired cardiac performance (right ventricle stroke volume 1.08 ± 0.04 ml/kg, fractional area change [FAC] 24 ± 0.5% and tricuspid annular peak systolic excursion [TAPSE] 7.46 ± 0.11mm). Serial information was available for 24 of 33 infants. Cardiac function improved significantly between the cooling and the re-warming kphases. This included changes in right ventricular output (127 ± 34 vs 164 ± 47 ml/kg/min, p <0.01) and FAC (20 ± 3 vs 28 ± 2%, p<0.01). Pairwise comparisons for fractional shortening did not show significant changes. From the cooling to the rewarming phase, maximum change was noted in FAC (26.3 ± 9.8%) while minimum change was noted in fractional shortening (median, interquartile range) of 4.6% (1.4, 9.1). Significant correlation between TAPSE and time to peak velocity as a proportion of right ventricular ejection time was noted (r2 = 0.68, p <0.001). CONCLUSIONS: In infants with moderate to severe HIE, cardiac function evolves during various phases of therapeutic hypothermia. Low output state during cooling may be due to a combination of the disease state (HIE) and cooling therapy. Show more

Keywords: Cardiac function, echocardiography, perinatal asphyxia, therapeutic hypothermia

DOI: 10.3233/NPM-1853

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 2, pp. 117-125, 2019

Authors: Preeti, S. | Kadam, A. | Kadam, S. | Vaidya, U. | Kumar, P. | Bhagat, I. | Pandit, A. | Chouthai, N.S.

Article Type: Research Article

Abstract: BACKGROUND: Perinatal asphyxia is a prominent cause of neonatal mortality in the developing world. Growth in head circumference is associated with improved neurodevelopment. Previous studies found a positive correlation between additional dietary supplementation and growth in head circumference among newborns with perinatal brain injury. This study aims to evaluate the association between anthropometric parameters and developmental outcomes in newborns with hypoxic ischemic encephalopathy (HIE). METHODS: Newborns at ≥36 weeks gestation with moderate to severe HIE were included in the study and growth parameters were monitored. Newborns with life-threatening anomalies were excluded. None of the study participants received therapeutic …hypothermia (TH). Developmental Assessment Scale for Indian Infants (DASII) was used to evaluate neurodevelopmental outcomes at 1 year of age. RESULTS: Of 76 study participants, 46 were followed for 12 months, 28 died, and 2 were lost to follow-up. HIE stage III, Apgar score <5 at 5 minutes of age, pH ≤ 7.1 on first blood gas and base deficit > – 16 was associated with death or disability at 1 year of age. All anthropometric parameters were significantly lower in presence of death or disability. pH ≤ 7.1 at birth (odds ratio: 11.835, 95% CI 2.273–61.629, p  = 0.003) and weight gain at one year (odds ratio 1.001, 95% CI 1.000–1.002, p  = 0.03) were significantly associated with death and disability. CONCLUSION: pH > 7.1 at birth, and weight gain were associated with better neurodevelopmental outcomes at 1 year of age. Thus, in addition to TH, nutritional interventions may potentially improve outcomes among newborns with HIE. Show more

DOI: 10.3233/NPM-17151

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 2, pp. 127-134, 2019

Authors: Toye, J.M. | Yang, J. | Sankaran, K. | Canadian Neonatal Network

Article Type: Research Article

Abstract: BACKGROUND: Mechanical ventilation (MV) causes discomfort but whether it causes pain remains controversial. Around the world neonatal intensive care units (NICU) often utilize narcotics and/or sedatives during MV of vulnerable infants yet the association with adverse neonatal outcomes has not been adequately addressed. OBJECTIVE: Test for associations between the use of narcotics/sedatives during MV and mortality/morbidity in preterm infants in a large infant cohort in Canada. DESIGN/METHODS: Preterm infants born <35 weeks gestational age (GA) requiring MV for >24 hrs were identified retrospectively from the Canadian Neonatal Network database, 2010–12. Infants were categorized according …to whether they received narcotics/sedatives for greater than 24 hours concurrently with MV. Infants were excluded if moribund on admission, had major congenital anomalies, diagnoses where narcotic administration is routine and suspected seizures. Multivariable logistic and linear regression analysis tested for association of narcotics/sedatives use during MV with mortality/morbidity (nosocomial infections, BPD, ROP, IVH) and length of MV. RESULTS: After exclusions the cohort included 2672 infants; 467(17%) exposed only to narcotics 101(4%) only to sedatives and 299(11%) to both. All models were adjusted for GA, gender, small for GA, SNAP-II score >20, multiple births, delivery mode, outborn, PDA status, MV type, use of high flow, muscle relaxant use, indwelling lines, caffeine and surfactant therapy. The composite mortality/morbidity, and MV days were significantly higher for MV infants exposed to narcotics, sedatives or both compared to infants not exposed. CONCLUSION: Mounting evidence of the adverse short and long-term impacts of narcotics/sedatives during MV supports the need for further work in alternative therapies. Show more

DOI: 10.3233/NPM-17157

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 2, pp. 135-141, 2019

Authors: Ku, L.C. | Simmons, C. | Smith, P.B. | Greenberg, R.G. | Fisher, K. | Hornik, C.D. | Cotten, C. Michael | Goldberg, R.N. | Bidegain, M.

Article Type: Research Article

Abstract: BACKGROUND: The intranasal route is a minimally invasive method for rapidly delivering midazolam and fentanyl to provide short-term analgesia and sedation in infants. However, intranasal use of midazolam and fentanyl is not labeled for infants and safety data are sparse. The objective of this study is to evaluate the safety of intranasal midazolam and intranasal fentanyl in infants admitted to the Neonatal Intensive Care Unit (NICU). METHODS: We retrospectively identified all infants receiving intranasal midazolam or fentanyl in the NICU from 2009 to 2015. We recorded indication for use and vital signs and determined the proportion …of infants experiencing the following adverse events: death within 24 hours, hypotension, bradycardia, worsening respiratory status, and chest wall rigidity. Vital signs 4 hours before and after each dose were compared using the Wilcoxon signed-rank test. RESULTS: We identified 17 infants (gestational ages 23– 41 weeks) receiving 25 intranasal doses. None of the infants died or developed hypotension, bradycardia, or chest wall rigidity. Intranasal delivery was most commonly used for sedation during magnetic resonance imaging studies. Other indications include analgesia or sedation for retinopathy of prematurity surgery, intubation, and peripherally inserted central catheter placement. One infant receiving intranasal midazolam experienced worsening respiratory status. Vital signs before and after dosing were not significantly different. CONCLUSIONS: Intranasal midazolam and fentanyl use in term and preterm infants appeared safe and well-tolerated in this small cohort of infants. Larger, prospective studies evaluating the safety and efficacy of intranasal midazolam and fentanyl use in infants are warranted. Show more

Keywords: Intranasal drug delivery, drug safety, infant pharmacology, procedural pain

DOI: 10.3233/NPM-17149

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 2, pp. 143-148, 2019

Authors: Sivieri, E.M. | Wolfson, M.R. | Abbasi, S.

Article Type: Research Article

Abstract: BACKGROUND: Infants are commonly supported with non-invasive ventilation (NIV) such as nasal CPAP and high flow nasal cannula (HFNC). These modes utilize a nasal/oral interface precluding use of a traditional airway flow sensor, such as a pneumotachometer (PNT), needed for pulmonary mechanics (PM) measurements. Respiratory Inductive Plethysmography (RIP), when properly calibrated, records tidal volume non-invasively from chest wall movements. Our aim was to integrate RIP into an existing neonatal pulmonary function testing system to measure PM in infants on NIV and to compare measurements of dynamic lung compliance (CL ) and resistance (RL ) using RIP with those obtained using …a PNT. DESIGN/METHODS: RIP ribcage (RC) and abdominal (ABD) signals were recorded simultaneously with the flow signal from a PNT; transpulmonary pressure was estimated using an esophageal catheter. Two calibration algorithms were applied to obtain RC and ABD scaling factors. RESULTS: Forty PM measurements were performed on 25 infants (GA 31.5±2.9 weeks; birth weight 1598±510 g; median age 7 days). Correlation coefficients for RIP- vs. PNT-based PM were r2  = 0.987 for CL and r2  = 0.997 for RL . From Bland-Altman analysis, the mean bias (±95% CI) between RIP and PNT methods was –0.004±0.021 ml/cmH2 O/kg for CL and 0.7±2.9 cmH2 O/(L/sec) for RL . The upper, lower limits of agreement (±95% CI) were 0.128±0.037, –0.135±0.037 ml/cmH2 O/kg for CL and 18.6±5.1, –17.2±5.1 cmH2 O/(L/sec) for RL . CONCLUSION: Properly calibrated RIP may be a useful tool with sufficient diagnostic accuracy for PM measurements without need for a nasal/oral airflow sensor in infants receiving NIV. Show more

Keywords: Respiratory inductive plethysmography, pulmonary mechanics, non-invasive respiratory support, premature infants

DOI: 10.3233/NPM-1869

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 2, pp. 149-159, 2019

Authors: Lee, M. | Wu, K. | Yu, A. | Roumiantsev, S. | Shailam, R. | Nimkin, K. | Sagar, P.

Article Type: Research Article

Abstract: BACKGROUND: Pulmonary hemorrhage (PH) is occasionally seen in premature infants after surfactant treatment for respiratory distress syndrome (RDS). These infants receive frequent chest radiographs (CXR) during and after hospitalization enabling long-term radiographic-clinical correlation. OBJECTIVE: To chart the natural evolution of CXR findings of PH in RDS and correlate radiographic patterns to supplemental oxygen requirement. MATERIALS AND METHODS: Retrospective review of clinical notes for gestational age (GA), birth weight (BW), intraventricular hemorrhage (IVH) and oxygen requirement were performed. CXRs were reviewed at 4 time-points; during PH, 28 days postnatal age, 36 weeks and at farthest available clinical …follow-up. RESULTS: 18 infants born (2003–2016), GA (24–30 weeks); BW (482–1590 grams) were included. Mean onset of PH was 1.94 (0–5) days. 9/18 (50%) had IVH. 3 died during PH; all had IVH. During PH, CXR showed whiteout 9/18 (50%); patchy opacities 5/18 (27%); diffuse haziness 1/18 (6%) and no change 3/18 (17%). At 28 days postnatal age, CXR showed fine-interstitial (FI) markings 14/15 (93%) and whiteout 1/15 (7%). At 36 weeks,12/14 (85%) had FI and 2/14 (15%) developed cystic-interstitial changes. At farthest follow-up, FI 3/13 (23%); coarse-interstitial 4/13 (30%); peri-bronchial cuffing 5/13 (38%); normal 1/13 (9%) and the majority had hyperinflation 9/13 (69%). At discharge, 9/14 (64%) required home-oxygen and 5/14 (36%) were on room-air. At farthest follow-up, 6/14 (42%) required home-oxygen and 8/14 (58%) were on room-air. CONCLUSION: Premature infants that survive PH may later develop chronic lung disease of prematurity with an evolving interstitial pattern on CXR that clears overtime as they outgrow the need for supplemental oxygen. Show more

Keywords: Pulmonary hemorrhage, respiratory distress syndrome, chronic lung disease of prematurity

DOI: 10.3233/NPM-1867

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 2, pp. 161-171, 2019

Authors: Attar, M.A. | Dechert, R.E. | Donn, S.M.

Article Type: Research Article

Abstract: INTRODUCTION: High frequency jet (HFJV) and oscillatory (HFOV) ventilation were used to rescue newborns with congenital diaphragmatic hernia (CDH), who failed conventional mechanical ventilation (CV). Changes in ventilator settings and pulmonary gas exchange were evaluated following transition to high frequency ventilation (HFV). METHODS: Records of patients with CDH rescued with HFV prior to surgical intervention between 2006 and 2015 were reviewed. Mean airway pressure (Pāw) and arterial blood gases during CV and those obtained within the first hour of HFV were compared. A composite repeated measure analysis was performed to evaluate longitudinal and intergroup variances. RESULTS: …Twenty-seven patients were rescued from CV, 16 by HFJV and 11 by HFOV. The two groups had similar gestational ages and birth weights. Prior to HFV, both groups had similar Pāw, PaCO2 , FiO2 and PaO2 . HFV was associated with a significant improvement in ventilation, and the rate of decrease of PaCO2 was no different between groups. There was a significantly higher increase in Pāw increase with HFOV compared to HFJV. CONCLUSIONS: In newborns with CDH rescued with HFV, ventilation improved but Pāw was significantly lower in patients supported with HFJV compared to HFOV. Show more

Keywords: Hemodynamic, rescue, respiratory failure, surgery, neonates

DOI: 10.3233/NPM-1813

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 2, pp. 173-178, 2019

Authors: Brown, R.A. | Dakkak, H. | Gilliland, J. | Seabrook, J.A.

Article Type: Research Article

Abstract: BACKGROUND: With limited Canadian research on predictors of drug use during pregnancy, the primary objective was to assess the relative effects of socioeconomic, demographic, and mental health risk factors associated with drug use during pregnancy. Predictors of an Apgar score < 7 and fetal macrosomia were examined as secondary outcomes. METHODS: This retrospective cohort study consisted of 25,734 pregnant women from Southwestern Ontario. Data were prospectively obtained from perinatal and neonatal databases at a tertiary hospital in London, Ontario. Using a Geographic Information System, neighborhood-level socioeconomic variables were obtained by mapping maternal postal codes. Separate logistic regressions were …computed for all outcome variables. RESULTS: The rates of alcohol, tobacco, and cannabis use during pregnancy were 1.9%, 16.2%, and 2.3%, respectively. The mean maternal age was 29.4±5.4 years. Maternal age was inversely associated with alcohol, tobacco and cannabis use, whereas lone-parent household, depression, and anxiety increased the odds of substance use. Depression was the top risk factor of all three substances. Compared to women who were not depressed during pregnancy, women who were depressed were 2.15 times more likely to use alcohol (95% CI: 1.60, 2.90), 1.70 times more likely to smoke tobacco (95% CI: 1.48, 1.95), and 2.56 times more likely to use cannabis (95% CI: 1.95, 3.35). Adverse birth outcomes were also associated with overweight and obesity, gestational diabetes and insulin-dependent diabetes. CONCLUSIONS: Maternal depression is the primary risk factor of drug use during pregnancy. Policy interventions that target at-risk women are important considerations to improve maternal mental health. Show more

Keywords: Alcohol, cannabis, tobacco, pregnancy, risk factors

DOI: 10.3233/NPM-1814

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 2, pp. 179-187, 2019

Authors: Zia, M.T.K. | Golombek, S. | Lemon, L. | Nitkowski Keever, S. | Paudel, U.

Article Type: Research Article

Abstract: BACKGROUND: Breastfeeding (BF) neonates generally lose weight after birth. Neonatal factors like gestational age, birth weight and mode of delivery can affect the neonatal weight loss after birth. Similarly, maternal age, parity and illness may contribute to newborn weight loss. However, influence of the time of birth and season on changes in weight is not well elucidated. OBJECTIVE: The aim of this study is to determine the effect of birth time and the seasonal variations on weight loss in BF newborns. METHODS: In this retrospective study of a prospectively maintained database of two sets of groups, …from January 2013 to October 2016, were evaluated- Birth time group and Seasonal group; Birth time of the groups was: night time 7pm to 7am and day time 7am to 7pm; and the seasonal variations groups studies were summer, fall, winter and spring. Weight loss of >5%, 7%, and 10% at <24 hours (h), 48 h and 72 h of birth, respectively, were considered as a significant weight loss. Preterm, exclusively formula fed and neonates admitted to NICU were excluded. RESULTS: A total of 2044 newborns were analyzed. In the birth time group, babies born during the night time had significantly lost >5% of birth weight at <24 h (p  < 0.01) and >7% birth weight at <48 h of life (p  < 0.02). Weight loss >10% at <72 h was similar in both birth time cohorts. C-section, prolonged rupture of membrane, and maternal pre-delivery hospital stay for >12 h were significant contributing factors. Whereas, seasonal variations were not associated with weight loss in neonates. CONCLUSION: BF babies born at night time lose significantly more weight during the first two days of life and seasonal association was not found to affect weight loss in the neonates. Show more

DOI: 10.3233/NPM-17137

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 2, pp. 189-194, 2019

Authors: Babgi, Mohammed A. | Al-Jifree, Hatim M. | AlShehri, Omar A. | Khan, Muhammad A. | Khogeer, Ahmad N. | Alqurashi, Mansour A.

Article Type: Research Article

Abstract: BACKGROUND: Neural tube defects (NTDs) are among the most common congenital anomalies worldwide with an incidence of 300,000/year. Spina bifida, which is the most prevalent NTD, has an incidence of 1.2/1000 live births in Saudi Arabia. Our study aimed to assess the awareness of NTDs and the implementation of preventative measures against them. In addition, to gauge public opinion regarding abortion following early diagnosis of NTDs. METHODS: This was a cross-sectional study in which questionnaires were distributed using non-probability convenient sampling technique and data was collected in a face-to-face interview. Subjects were approached in an outpatient clinic and …in a shopping mall in Jeddah city, Saudi Arabia. RESULTS: Out of 353 subjects, 35.7% were males, 64.3% females (33% pregnant), and the median age was 34 (IQR = 14) years. Of subjects, 66.3% were not aware of NTDs, and regarding folic acid 54% believed that it helps in preventing NTDs, and only 25% agreed on starting it before pregnancy. However, only 19% agreed on all points, which even dropped to 9% after considering planned pregnancies. Gender differences were extremely significant (p -value <0.001) as females were more aware. Interestingly, 62% would abort in early-diagnosed NTD cases. Of pregnant women, only 20% started taking folic acid before pregnancy. CONCLUSIONS: The data shows that the majority of the study’s population are in favor of terminating the pregnancy in justified NTD cases. There is a need for increasing public awareness, especially to males, and should be provided through all channels of knowledge. Show more

Keywords: Neural tube defects, folic acid, pregnancy termination, periconceptional use, Saudi Arabia

DOI: 10.3233/NPM-17165

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 2, pp. 195-201, 2019

Authors: Cantú-Reyna, C. | Santos-Guzmán, J. | Cruz-Camino, H. | Vazquez Cantu, D.L. | Gómez-Gutiérrez, R. | Góngora-Cortéz, J.J. | Gutiérrez-Castillo, A.

Article Type: Research Article

Abstract: Glucose-6-phosphate dehydrogenase deficiency (D-G6PD) is a common erythroenzymopathy that needs to be addressed as an important public health issue. Proper population monitoring is needed to anticipate clinical complications. A joint venture between Genomi-k (a Mexican company focused on newborn screening) and several university researchers conducted a retrospetive study for D-G6PD based on 156,152 newborn screening reports belonging to the Mexican population comprising a period of 10 years. We identified 540 male newborns affected with this deficiency, representing an incidence of 6.78 cases per 1,000 newborn males. A single double mutation of G202A:A376G was detected in 97.22% of cases. In regions …where there is an absence of a national centralized health data for D-G6PD, information from a non-probabilistic large population sample can be used as a national incidence subrogate. Show more

Keywords: G6PD, incidence, Mexico, newborn screening

DOI: 10.3233/NPM-1831

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 2, pp. 203-207, 2019

Authors: Rabiepoor, S. | Abedi, M. | Saboory, E. | Khalkhali, H.R.

Article Type: Research Article

Abstract: BACKGROUND: The present study aimed to determine the effect of perceived stress during pregnancy on neonatal outcomes and cortisol and leptin levels in mothers and their newborns. METHODS: This longitudinal study was carried out on 110 pregnant women in Miandoab city, Iran. Mothers, who had singleton pregnancies and gestational age of 24 to 28 weeks, were included in the study. The participants were asked to fill out Cohen’s Perceived Stress Scale (PSS). The mothers were then tracked in gestational ages of 28–32 weeks, 32–36 weeks, and the time of delivery. The maternal and umbilical cord blood samples were …obtained during labor in order to measure leptin and cortisol levels. RESULTS: Umbilical cortisol level was significantly higher in newborns who had meconium stained amniotic fluid than those who did not. Maternal blood leptin levels at delivery were significantly higher in the mothers whose neonates had respiratory distress, low birth weight, low head circumference, low Apgar score, and were premature than those whose neonates did not have such problems. The level of leptin in umbilical cord blood was significantly higher in neonates who had respiratory distress than those who did not. The results also showed a significant correlation between maternal cortisol levels and PSS during weeks 24–28 and the entire pregnancy. A significant relationship was observed between umbilical leptin and maternal leptin levels. CONCLUSIONS: It can be concluded that stress during pregnancy is accompanied by fetal distress. The probable reason for newborns distress may be related to increased maternal leptin levels. Show more

Keywords: Perceived stress, pregnancy, cortisol, leptin, umbilical cord, fetal growth

DOI: 10.3233/NPM-1818

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 2, pp. 209-219, 2019

Authors: Kratimenos, Panagiotis | Christidis, Panagiotis | Kehinde, Folasade | Koutroulis, Ioannis | Santana, Stephanie | Mossabeb, Roschanak | Fleishman, Rachel

Article Type: Research Article

Abstract: BACKGROUND: Premature neonates are often subjected to multiple transfusions with red blood cells during their hospitalization in the neonatal intensive care unit (NICU). The hemoglobin threshold for transfusion prior to discharge from the NICU varies significantly among different centers. The aim of the present study is to investigate the association between hemoglobin concentration at discharge with neurodevelopmental outcomes in premature neonates. METHODS: Retrospective observation study with regression analysis was performed with follow up assessment in the neuro-developmental outpatient clinic at 30 months of adjusted age. RESULTS: Data from 357 neonates born at less than 37 weeks’ …gestation were analyzed. Sensory and motor neurodevelopment at 30 months of adjusted age, were not associated with the hemoglobin concentration at discharge (p=0.5891 and p=0.4575, respectively). There was no association between the hemoglobin concentration at discharge with fine or gross motor development (p=0.1582 and p=0.3805, respectively). Hemoglobin concentration at discharge was not associated with poor neurodevelopmental outcomes up until 30 months of adjusted age. CONCLUSIONS: The data of the present study indicate that the hemoglobin concentration of premature neonates at the time of discharge is not associated with poorer markers of neurodevelopmental outcomes at 30 months of adjusted age. Comorbidities such as BPD and IVH that are present to premature neonates were identified as potential risk factors for certain aspects of the neurodevelopment. Show more

Keywords: Hemoglobin, discharge, neurodevelopment, transfusion, NEC, premature neonates, NICU

DOI: 10.3233/NPM-1822

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 2, pp. 221-230, 2019

Authors: Kumar, D. | Vachharajani, A.J. | Wertheimer, F. | Vergales, B. | Glass, K. | Dannaway, D. | Winter, L. | Delaney, H. | Ganster, A. | Arnold, J. | Urban, A. | Johnston, L. | Bruno, C. | Gray, M.M. | Sawyer, T. | for the Organization of Neonatal Training Program Directors Task Force on Simulation

Article Type: Research Article

Abstract: BACKGROUND: Simulation is widely used in graduate medical education. A prior survey showed that 80% of Neonatal-Perinatal Medicine (NPM) fellowship programs in the U.S. use simulation. There are multiple ways to provide simulation-based education. One such method is through intensive simulation-based education sessions held at the beginning of a training program, common called ‘boot camps’. The aim of this study was to describe the use of simulation-based boot camps in NPM fellowship programs. METHODS: Survey study of Accreditation Council for Graduate Medical Education (ACGME) accredited NPM fellowships in the U.S. RESULTS: Fifty-nine of 98 programs (60%) …responded. Thirty six (61%) participated in 1st year fellow boot camps, which focused on procedural skills and newborn resuscitation. Nearly half of programs participated in regional boot camps. Most boot camps were one or two days long. Eleven programs (19%) held 2nd or 3rd year fellow boot camps, which focused on advanced resuscitation and communication. Barriers included lack of faculty protected time (57%), funding (39%), and lack of faculty experience (31%). CONCLUSIONS: A majority of ACGME accredited NPM fellowships participate in 1st year fellows’ boot camps. Many participate in regional boot camps. A few programs have 2nd or 3rd year fellow boot camps. Lack of time, funding, and faculty experience were common barriers. Show more

Keywords: Boot camp, simulation, Neonatal-perinatal medicine, neonatal fellowship

DOI: 10.3233/NPM-18117

Citation: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 2, pp. 231-237, 2019