-
[show abstract]
[hide abstract]
ABSTRACT: Neonatal Resuscitation Program instructors spend most of their classroom time giving lectures and demonstrating basic skills. We hypothesized that a self-directed education program could shift acquisition of these skills outside the classroom, shorten the duration of the class, and allow instructors to use their time to facilitate low-fidelity simulation and debriefing.
Novice providers were randomly allocated to self-directed education or a traditional class. Self-directed participants received a textbook, instructional video, and portable equipment kit and attended a 90-minute simulation session with an instructor. The traditional class included 6 hours of lectures and instructor-directed skill stations. Outcome measures included resuscitation skill (megacode assessment score), content knowledge, participant satisfaction, and self-confidence.
Forty-six subjects completed the study. There was no significant difference between the study groups in either the megacode assessment score (23.8 [traditional] vs 24.5 [self-directed]; P = .46) or fraction that passed the "megacode" (final skills assessment) (56% [traditional] vs 65% [self-directed]; P = .76). There were no significant differences in content knowledge, course satisfaction, or postcourse self-confidence. Content knowledge, years of experience, and self-confidence did not predict resuscitation skill.
Self-directed education improves the educational efficiency of the neonatal resuscitation course by shifting the acquisition of cognitive and basic procedural skills outside of the classroom, which allows the instructor to add low-fidelity simulation and debriefing while significantly decreasing the duration of the course.
PEDIATRICS 03/2011; 127(4):713-9. · 4.47 Impact Factor
-
John Kattwinkel,
Jeffrey M Perlman,
Khalid Aziz,
Christopher Colby,
Karen Fairchild,
John Gallagher,
Mary Fran Hazinski,
Louis P Halamek,
Praveen Kumar,
George Little,
Jane E McGowan,
Barbara Nightengale,
Mildred M Ramirez,
Steven Ringer,
Wendy M Simon, Gary M Weiner,
Myra Wyckoff,
Jeanette Zaichkin
Circulation 11/2010; 122(18 Suppl 3):S909-19. · 14.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We have isolated mesenchymal stem cells (MSCs) from tracheal aspirates of premature infants with respiratory distress. Under the influence of transforming growth factor β, MSCs differentiate into α-smooth-muscle actin-expressing myofibroblasts. Myofibroblasts are increased in the lungs of patients with bronchopulmonary dysplasia (BPD), a chronic lung disease of prematurely born infants.
We tested whether isolation of MSCs from tracheal aspirates of premature infants with respiratory distress during the first week of life correlates with BPD.
Eighty-four infants born at a gestational age of <33 weeks and requiring mechanical ventilation were studied. Aspirates were collected during suctioning and centrifuged. Cell pellets were resuspended in culture medium and plated. Adherent cells were grown to confluence.
MSCs were isolated from the tracheal aspirates of 56 infants; 28 aspirate samples showed no MSCs. There was no statistical difference in gestational age or birth weight between the MSC and no-MSC groups. In the MSC group, 12 infants died and 25 developed BPD, as defined by a requirement for supplemental oxygen at 36 weeks' postmenstrual age. In the no-MSC group, 6 infants died and 1 developed BPD. Accounting for potential influences of gender, birth weight, gestational age, number of tracheal aspirate samples taken, and the duration of endotracheal intubation (up to 7 days), isolation of MSCs increased the adjusted odds ratio of BPD more than 21-fold (95% confidence interval: 1.82-265.85).
Isolation of tracheal aspirate MSCs predicts the development of BPD, which suggests that MSCs play an important role in the pathogenesis of this disease.
PEDIATRICS 10/2010; 126(5):e1127-33. · 4.47 Impact Factor
-
John Kattwinkel,
Jeffrey M Perlman,
Khalid Aziz,
Christopher Colby,
Karen Fairchild,
John Gallagher,
Mary Fran Hazinski,
Louis P Halamek,
Praveen Kumar,
George Little,
Jane E McGowan,
Barbara Nightengale,
Mildred M Ramirez,
Steven Ringer,
Wendy M Simon, Gary M Weiner,
Myra Wyckoff,
Jeanette Zaichkin
PEDIATRICS 10/2010; 126(5):e1400-13. · 4.47 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The appropriate role for laryngeal masks during delivery room resuscitation has not been established. The authors systematically reviewed the literature to answer three clinical questions: (1) In newborns requiring positive-pressure ventilation for resuscitation, would a laryngeal mask achieve safe and effective ventilation faster than facemask ventilation? (2) In newborns unable to be ventilated effectively with a facemask during resuscitation, would a laryngeal mask achieve effective ventilation faster than endotracheal intubation? (3) In newborns requiring resuscitation, would a laryngeal mask achieve effective ventilation when facemask ventilation and endotracheal intubation have been unsuccessful?
Clinics in Perinatology 04/2006; 33(1):99-110, vii. · 2.46 Impact Factor
-
Pediatrics in Review 02/2002; 23(1):3-9. · 0.55 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In spring 2011, the American Academy of Pediatrics (AAP) will release sixth edition materials for the Neonatal Resuscitation Program (NRP). This edition brings changes in resuscitation practice and a new education methodology that shifts the instructor from "teacher" to "learning facilitator" and requires the NRP course participant to assume more responsibility for learning. The change from a lecture format to simulation-based learning requires instructors to learn new skills and meet new requirements to maintain instructor status. The sixth edition of the Textbook of Neonatal Resuscitation and the fifth edition of the Instructor's Manual for Neonatal Resuscitation are currently in press. The AAP granted permission to use material from these forthcoming publications in this article.
Neonatal network: NN 30(1):5-13.
