Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Failure of pediatric and neonatal trainees to meet Canadian Neonatal Resuscitation Program standards for neonatal intubation

Abstract

Objective:

Neonatal intubation skills are initially taught through the Neonatal Resuscitation Program (NRP) and thereafter complemented by further practical clinical training. The aim of this study is to compare the ability of NRP trained individuals to successfully complete a neonatal intubation.

Study Design:

A prospective observational study was performed at an inborn high-risk level 3 perinatal center. Participants were postgraduate years 1 and 3 pediatric residents, neonatal–perinatal medicine subspecialty residents and fellows, and neonatal intensive care unit (NICU) respiratory therapists (RTs) with earlier NRP training. Intubations were scored on a checklist as well as a global assessment scale. Characteristics of the intubation attempt were recorded for each patient.

Result:

Fifty neonatal intubations were assessed, of which 73% of the attempts were deemed successful. A higher proportion of endotracheal tubes were successfully placed by RTs (100%, P<0.05), compared with both NICU fellows (69%) and pediatric residents (63%). The overall mean time for successful neonatal intubation was 51±28 s, which is greater than twice the time currently recommended by the NRP and American Heart Association guidelines. Attempts by pediatric residents and NICU fellows were longer (P<0.05, analysis of variance) and received lower global assessment scale (P<0.05, analysis of variance) and checklist (P<0.05, analysis of variance) scores, when compared with RTs.

Conclusion:

The success rate and overall quality of neonatal intubations performed by neonatal and pediatric trainees in Canada did not meet NRP standards; in particular, the time taken to intubate by pediatric residents and neonatal fellows is concerning. Re-evaluation of training methods and the volume of formalized exposure to neonatal intubation in Canadian residency programs are required.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Royal College of Physicians and Surgeons of Canada. Specific standards of accreditation for residency programs in pediatrics. 2008. http://rcpsc.medical.org/residency/accreditation/ssas/peds_e.pdf.

  2. White JR, Shugerman R, Brownlee C, Quan L . Performance of advanced resuscitation skills by pediatric housestaff. Arch Pediatr Adolesc Med 1998; 152 (12): 1232–1235.

    Article  CAS  Google Scholar 

  3. Nadel FM, Lavelle JM, Fein JA, Giardino AP, Decker JM, Durbin DR . Assessing pediatric senior residents' training in resuscitation: fund of knowledge, technical skills, and perception of confidence. Pediatr Emerg Care 2000; 16 (2): 73–76.

    Article  CAS  Google Scholar 

  4. Buss PW, McCabe M, Evans RJ, Davies A, Jenkins H . A survey of basic resuscitation knowledge among resident paediatricians. Arch Dis Child 1993; 68 (1): 75–78.

    Article  CAS  Google Scholar 

  5. O'Donnell CP, Kamlin CO, Davis PG, Morley CJ . Endotracheal intubation attempts during neonatal resuscitation: success rates, duration, and adverse effects. Pediatrics 2006; 117 (1): e16–e21.

    Article  Google Scholar 

  6. Leone TA, Rich W, Finer NN . Neonatal intubation: success of pediatric trainees. J Pediatr 2005; 146 (5): 638–641.

    Article  Google Scholar 

  7. Falck AJ, Escobedo MB, Baillargeon JG, Villard LG, Gunkel JH . Proficiency of pediatric residents in performing neonatal endotracheal intubation. Pediatrics 2003; 112 (6 Pt 1): 1242–1247.

    Article  Google Scholar 

  8. American Heart Association, American Academy of Pediatrics. 2005 American heart association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: neonatal resuscitation guidelines. Pediatrics 2006; 117 (5): e1029–e1038.

    Article  Google Scholar 

  9. Kattwinkel J . (ed). Textbook of Neonatal Resuscitation. American Academy of Pediatrics and American Heart Association: Elk Grove Village, IL, 2006.

    Google Scholar 

  10. Lane B, Finer N, Rich W . Duration of intubation attempts during neonatal resuscitation. J Pediatr 2004; 145 (1): 67–70.

    Article  Google Scholar 

  11. Marshall TA, Deeder R, Pai S, Berkowitz GP, Austin TL . Physiologic changes associated with endotracheal intubation in preterm infants. Crit Care Med 1984; 12 (6): 501–503.

    Article  CAS  Google Scholar 

  12. Jewkes F, Phillips B . Resuscitation training of paediatricians. Arch Dis Child 2003; 88 (2): 118–121.

    Article  CAS  Google Scholar 

  13. Durojaiye L, O'Meara M . Improvement in resuscitation knowledge after a one-day paediatric life-support course. J Paediatr Child Health 2002; 38 (3): 241–245.

    Article  CAS  Google Scholar 

  14. Quan L, Shugerman RP, Kunkel NC, Brownlee CJ . Evaluation of resuscitation skills in new residents before and after pediatric advanced life support course. Pediatrics 2001; 108 (6): E110.

    Article  CAS  Google Scholar 

  15. Halamek LP, Kaegi DM, Gaba DM, Sowb YA, Smith BC, Smith BE et al. Time for a new paradigm in pediatric medical education: teaching neonatal resuscitation in a simulated delivery room environment. Pediatrics 2000; 106 (4): E45.

    Article  CAS  Google Scholar 

  16. de Oliveira Filho GR . The construction of learning curves for basic skills in anesthetic procedures: an application for the cumulative sum method. Anesth Analg 2002; 95 (2): 411–416, table of contents.

    PubMed  Google Scholar 

  17. Mulcaster JT, Mills J, Hung OR, MacQuarrie K, Law JA, Pytka S et al. Laryngoscopic intubation: learning and performance. Anesthesiology 2003; 98 (1): 23–27.

    Article  Google Scholar 

Download references

Acknowledgements

We thank the members of the department of respiratory therapy, Mount Sinai Hospital, for the time and effort invested in the collection of this data.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to E Finan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bismilla, Z., Finan, E., McNamara, P. et al. Failure of pediatric and neonatal trainees to meet Canadian Neonatal Resuscitation Program standards for neonatal intubation. J Perinatol 30, 182–187 (2010). https://doi.org/10.1038/jp.2009.152

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2009.152

Keywords

This article is cited by

Search

Quick links