O3223: Virtual simulations to improve skills in neonatal resuscitation and care: A secondary analysis from the vENC study

Background: Globally, a child’s risk of death is highest during the first 28 days of life. One third of neonatal deaths occur on the first day alone, with 60% due to preventable causes. The Virtual Essential Newborn Care (vENC) application was developed to support the ongoing practice of newborn resuscitation along with essential newborn care as presented in the World Health Organization’s (WHO’s) recently released Essential Newborn Care Course (ENCC). These extended simulations were developed to provide low-dose, high-frequency practice opportunities for more comprehensive newborn care, and to support skills retention for health professionals recently trained in ENCC.

Methods: We hypothesized that vENC efficacy would be impacted by demographics of health professional users, specifically, that vENC would be more effective with younger and less experienced health professionals. The study was conducted in Lagos, Nigeria. Participants were recruited from 23 urban healthcare facilities (14 primary, 7 secondary and 2 tertiary). To ensure that all participants received the same initial training and baseline assessments, a 2-day in-person ENC1 and ENC2 course was conducted by experienced facilitators using the WHO ENCC training materials. Training assessments consisted of knowledge tests (knowledge check or KC), performance of bag and mask ventilation (BMV), and four case scenarios (CS at baseline, immediately and 6 months post-course.

Results: Participants with >20 years of experience had significantly higher pre-course KC1 scores compared with those with < 5 years of experience (p < 0.05). Figure 2. Pre-course practical skills (BMV and CS) scores were relatively low (mean, 33-50%, SD, 15-25%). On the average, pre-training BMV scores were higher with increasing facility level and years of experience (p = < 0.05) but the significance was lost after training and this performance level was maintained at 6 months post-course. There were no differences by demographic characteristics in pre- and immediate post-course CS performance. However, at 6 months, the median change in scores was greater in participants aged >40 years compared to 21-30 years (CSA2, +13 vs. -4, p=0.013). Those who had been trained prior to this study had greater median change in CS performance at 6 months compared to immediate post course (CSB1, +11.0 vs. +2.8, p=0.034; CSB2, +13.6 vs. +2.9, p=0.046).

Conclusion: ENCC training increased knowledge and skills in newborn resuscitation and neonatal care for nurses and midwives at all levels of facility practice and experience. Using vENC simulations post-course supported skills performance in all groups at 6 months with the possibility of greater benefit in experienced providers. Using vENC simulations post-course supported skills performance in all groups at 6 months with the possibility of greater benefit in experienced providers.