Pharmacological and non-pharmacological treatments for the Neonatal Abstinence Syndrome (NAS).

Neonatal abstinence syndrome is defined by signs and symptoms of withdrawal that infants develop after intrauterine maternal drug exposure. All infants with documented in utero opioid exposure, or a high pre-test probability of exposure should have monitoring with a standard assessment instrument such as a Finnegan Score. A Finnegan score of \u3e8 is suggestive of opioid exposure, even in the absence of declared use during pregnancy. At least half of infants in most locales can be treated without the use of pharmacologic means. For this reason, symptom scores will drive the decision for pharmacologic therapy. Nevertheless, all infants, regardless of initial manifestations, should be first be managed with non-pharmacologic approaches which in turn, should not be considered as the sole alternative to drug therapy, but rather, as the base upon which all patients are treated. Those who continue to have symptoms despite supportive care should be pharmacologically treated, which in the most severe cases, is life-saving

Growth Mindset Moderates the Effect of the Neonatal Resuscitation Program on Performance in a Computer-Based Game Training Simulation

This study examines for the first time the moderating role of growth mindset on the association between the time elapsed since participants' last refresher neonatal resuscitation program (NRP) course and their performance on neonatal resuscitation tasks in the RETAIN computer game training simulation. Participants were n = 50 health-care providers affiliated with a large university hospital. Results revealed that growth mindset moderated the relation between participants' task performance in the game and the time since their latest refresher NRP course. Specifically, participants who completed the course more recently (i.e., between 8 and 9 months before the current study) made significantly more mistakes in the game than the rest of the participants but only when they endorsed lower levels of growth mindset. Implications of this research include growth mindset interventions and increased screen time in simulation sessions that have the potential to help health-care providers achieve better performance on neonatal resuscitation clinical tasks

RETAIN: A Board Game That Improves Neonatal Resuscitation Knowledge Retention

Background: The current resuscitation guidelines recommend frequent simulation based medical education (SBME). However, the current SBME approach is expensive, time-intensive, and requires a specialized lab and trained instructors. Hence, it is not offered routinely at all hospitals. We designed the board game “RETAIN” to train healthcare providers (HCPs) in neonatal resuscitation in a cost-friendly and accessible way.Objectives: To examine if a board game-based training simulator improves knowledge retention in HCPs.Methods: “RETAIN” consists of a board using an image of a baby, visual objects, adjustable timer, monitors, and action cards. Neonatal HCPs at the Royal Alexandra Hospital were invited to participate. Participants completed a written pre-test (resuscitation of a 24-week infant), then played the board game (starting with a tutorial followed by free playing of three evidence-based neonatal resuscitation scenarios). Afterwards, a post-test with the same resuscitation scenario and an opinion survey was completed. The answers from the pre- and post-test were compared to assess HCPs' knowledge retention.Results: Thirty HCPs (four doctors, 12 nurses, and 14 respiratory therapist) participated in the study. Overall, we observed a 10% increase in knowledge retention between the pre- and post-test (49–59%, respectively). Temperature management showed the most knowledge gain between the pre- and post-test (14–46%, respectively). Placement of a hat (10–43%), plastic wrap (27–67%), and temperature probe (7–30%) improved between the pre- and post-test.Conclusion: Knowledge retention increased by 12% between pre- and post-test (49–61%, respectively). The improvement in performance and knowledge supports the use of board game simulations for clinical training

The route, dose, and interval of epinephrine for neonatal resuscitation: a systematic review

CONTEXT: Current International Liaison Committee on Resuscitation recommendations on epinephrine administration during neonatal resuscitation were derived in 2010 from indirect evidence in animal or pediatric studies. OBJECTIVE: Systematic review of human infant and relevant animal studies comparing other doses, routes, and intervals of epinephrine administration in neonatal resuscitation with (currently recommended) administration of 0.01 to 0.03 mg/kg doses given intravenously (IV) every 3 to 5 minutes. DATA SOURCES: Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, and trial registry databases. STUDY SELECTION: Predefined criteria were used for selection. DATA EXTRACTION: Risk of bias was assessed by using published tools appropriate for the study type. Certainty of evidence was assessed by using Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Only 2 of 4 eligible cohort studies among 593 unique retrieved records yielded data allowing comparisons. There were no differences between IV and endotracheal epinephrine for the primary outcome of death at hospital discharge (risk ratio = 1.03 [95% confidence interval 0.62 to 1.71]) or for failure to achieve return of spontaneous circulation, time to return of spontaneous circulation (1 study; 50 infants), or proportion receiving additional epinephrine (2 studies; 97 infants). There were no differences in outcomes between 2 endotracheal doses (1 study). No human infant studies were found in which authors addressed IV dose or dosing interval. LIMITATIONS: The search yielded sparse human evidence of very low certainty (downgraded for serious risk of bias and imprecision). CONCLUSIONS: Administration of epinephrine by endotracheal versus IV routes resulted in similar survival and other outcomes. However, in animal studies, researchers continue to suggest benefit of IV administration using currently recommended doses