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Article ; Online: Large-scale implementation of Helping Babies Breathe - what is required?

Ersdal, Hege Langli

Paediatrics and international child health

2018 Volume 38, Issue 1, Page(s) 1–4

MeSH term(s)	Asphyxia Neonatorum ; Humans ; Infant ; Infant Mortality
Language	English
Publishing date	2018
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	2649065-1
ISSN	2046-9055 ; 2046-9047
ISSN (online)	2046-9055
ISSN	2046-9047
DOI	10.1080/20469047.2017.1356626
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Zs.A 1674: Show issues

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Article ; Online: Use of newborn heart rate to determine need for resuscitation at birth.

Kibsgaard, Amalie / Ersdal, Hege / Kvaløy, Jan Terje / Eilevstjønn, Joar / Rettedal, Siren

Acta paediatrica (Oslo, Norway : 1992)

2024 Volume 113, Issue 4, Page(s) 837–838

MeSH term(s)	Infant, Newborn ; Humans ; Heart Rate/physiology ; Resuscitation
Language	English
Publishing date	2024-01-26
Publishing country	Norway
Document type	Letter
ZDB-ID	203487-6
ISSN	1651-2227 ; 0365-1436 ; 0803-5253
ISSN (online)	1651-2227
ISSN	0365-1436 ; 0803-5253
DOI	10.1111/apa.17132
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Um IV Zs.95: Show issues

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Article ; Online: How Much Training Is Enough? Low-Dose, High-Frequency Simulation Training and Maintenance of Competence in Neonatal Resuscitation.

Haynes, Joanna C / Rettedal, Siren I / Ushakova, Anastasia / Perlman, Jeffrey M / Ersdal, Hege L

Simulation in healthcare : journal of the Society for Simulation in Healthcare

2024

Abstract: Introduction: Facemask ventilation is a crucial, but challenging, element of neonatal resuscitation.In a previously reported study, instructor-led training using a novel neonatal simulator resulted in high-level ventilation competence for health care ... ...

Abstract	Introduction: Facemask ventilation is a crucial, but challenging, element of neonatal resuscitation.In a previously reported study, instructor-led training using a novel neonatal simulator resulted in high-level ventilation competence for health care providers (HCPs) involved in newborn resuscitation. The aim of this study was to identify the optimal frequency and dose of simulation training to maintain this competence level. Methods: Prospective observational study of HCPs training through 9 months. All training was logged. Overall ventilation competence scores were calculated for each simulation case, incorporating 7 skill elements considered important for effective ventilation.Overall scores and skill elements were analyzed by generalized linear mixed effects models using frequency (number of months of 9 where training occurred and total number of training sessions in 9 months) and dose (total number of cases performed) as predictors. Training loads (frequency + dose) predictive of high scores were projected based on estimated marginal probabilities of successful outcomes. Results: A total of 156 HCPs performed 4348 training cases. Performing 5 or more sessions in 9 months predicted high global competence scores (>28/30). Frequency was the best predictor for 4 skill elements; success in maintaining airway patency and ventilation fraction was predicted by performing training in, respectively, 2 and 3 months of 9, whereas for avoiding dangerously high inflating pressures and providing adequate mask seal, 5 and 6 sessions, respectively, over the 9 months, predicted success. Skills reflecting global performance (successful resuscitation and valid ventilations) and ventilation rate were more dose-dependent. Conclusions: Training frequency is important in maintaining neonatal ventilation competence. Training dose is important for some skill elements. This offers the potential for individualized training schedules.
Language	English
Publishing date	2024-03-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2223429-9
ISSN	1559-713X ; 1559-2332
ISSN (online)	1559-713X
ISSN	1559-2332
DOI	10.1097/SIH.0000000000000783
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Article ; Online: Newborn resuscitation timelines: Accurately capturing treatment in the delivery room.

Pike, Hanne / Kolstad, Vilde / Eilevstjønn, Joar / Davis, Peter G / Ersdal, Hege Langli / Rettedal, Siren

Resuscitation

2024 Volume 197, Page(s) 110156

Abstract: Objectives: To evaluate the use of newborn resuscitation timelines to assess the incidence, sequence, timing, duration of and response to resuscitative interventions.: Methods: A population-based observational study conducted June 2019-November 2021 ... ...

Abstract	Objectives: To evaluate the use of newborn resuscitation timelines to assess the incidence, sequence, timing, duration of and response to resuscitative interventions. Methods: A population-based observational study conducted June 2019-November 2021 at Stavanger University Hospital, Norway. Parents consented to participation antenatally. Newborns ≥28 weeks' gestation receiving positive pressure ventilation (PPV) at birth were enrolled. Time of birth was registered. Dry-electrode electrocardiogram was applied as soon as possible after birth and used to measure heart rate continuously during resuscitation. Newborn resuscitation timelines were generated from analysis of video recordings. Results: Of 7466 newborns ≥28 weeks' gestation, 289 (3.9%) received PPV. Of these, 182 had the resuscitation captured on video, and were included. Two-thirds were apnoeic, and one-third were breathing ineffectively at the commencement of PPV. PPV was started at median (quartiles) 72 (44, 141) seconds after birth and continued for 135 (68, 236) seconds. The ventilation fraction, defined as the proportion of time from first to last inflation during which PPV was provided, was 85%. Interruption in ventilation was most frequently caused by mask repositioning and auscultation. Suctioning was performed in 35% of newborns, in 95% of cases after the initiation of PPV. PPV was commenced within 60 s of birth in 49% of apnoeic and 12% of ineffectively breathing newborns, respectively. Conclusions: Newborn resuscitation timelines can graphically present accurate, time-sensitive and complex data from resuscitations synchronised in time. Timelines can be used to enhance understanding of resuscitation events in data-guided quality improvement initiatives.
MeSH term(s)	Pregnancy ; Infant, Newborn ; Humans ; Female ; Delivery Rooms ; Resuscitation ; Positive-Pressure Respiration ; Intermittent Positive-Pressure Ventilation ; Gestational Age
Language	English
Publishing date	2024-02-27
Publishing country	Ireland
Document type	Observational Study ; Journal Article
ZDB-ID	189901-6
ISSN	1873-1570 ; 0300-9572
ISSN (online)	1873-1570
ISSN	0300-9572
DOI	10.1016/j.resuscitation.2024.110156
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Zs.A 1048: Show issues

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Article: When early and often counts.

Ersdal, Hege

The practising midwife

2015 Volume 18, Issue 8, Page(s) 9–11

Abstract: In 2000, Millennium Development Goal 4 called for global deaths in under fives, to be reduced by two thirds by 2015 (United Nations Millennium Declaration (UNMD) 2000). Birth asphyxia - failure to initiate or sustain spontaneous breathing at birth - ... ...

Abstract	In 2000, Millennium Development Goal 4 called for global deaths in under fives, to be reduced by two thirds by 2015 (United Nations Millennium Declaration (UNMD) 2000). Birth asphyxia - failure to initiate or sustain spontaneous breathing at birth - causes up to one million neonatal deaths per year (Ersdal and Singhal 2013). A high proportion.of these are in low-resource countries. In 2009, a group of doctors and academics from hospitals and universities in Norway and the United States wanted to find out if the Helping babies breathe (HBB) simulation-based programme for midwives in low-resource countries helped reduce newborn fatalities in a hospital in Tanzania. I was one of those doctors and our research showed that when teaching switched from a one-day programme to a low-dose, high-frequency model, emphasising immediate basic steps, there was a significant increase in the number of infants stimulated at birth, and a 40 per cent decrease in early neonatal mortality.
MeSH term(s)	Asphyxia Neonatorum/mortality ; Asphyxia Neonatorum/nursing ; Clinical Competence ; Developing Countries ; Humans ; Infant ; Infant Mortality/trends ; Inservice Training/organization & administration ; Midwifery/education ; Midwifery/methods ; Norway ; Resuscitation/education ; Resuscitation/nursing ; Tanzania ; Teaching/organization & administration ; United States
Language	English
Publishing date	2015-09
Publishing country	England
Document type	Journal Article
ZDB-ID	1427227-1
ISSN	1461-3123
ISSN	1461-3123
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Zs.A 4890: Show issues

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Article: Use of Pulse Oximetry during Resuscitation of 230 Newborns-A Video Analysis.

Kolstad, Vilde / Pike, Hanne / Eilevstjønn, Joar / Buskov, Frederikke / Ersdal, Hege / Rettedal, Siren

Children (Basel, Switzerland)

2023 Volume 10, Issue 7

Abstract: Background: European guidelines recommend the use of pulse oximetry (PO) during newborn resuscitation, especially when there is a need for positive pressure ventilation or supplemental oxygen. The objective was to evaluate (i) to what extent PO was used, ...

Abstract	Background: European guidelines recommend the use of pulse oximetry (PO) during newborn resuscitation, especially when there is a need for positive pressure ventilation or supplemental oxygen. The objective was to evaluate (i) to what extent PO was used, (ii) the time and resources spent on the application of PO, and (iii) the proportion of time with a useful PO signal during newborn resuscitation. Methods: A prospective observational study was conducted at Stavanger University Hospital, Norway, between 6 June 2019 and 16 November 2021. Newborn resuscitations were video recorded, and the use of PO during the first ten minutes of resuscitation was recorded and analysed. Results: Of 7466 enrolled newborns, 289 (3.9%) received ventilation at birth. The resuscitation was captured on video in 230 cases, and these newborns were included in the analysis. PO was applied in 222 of 230 (97%) newborns, median (quartiles) 60 (24, 58) seconds after placement on the resuscitation table. The proportion of time used on application and adjustments of PO during ongoing ventilation and during the first ten minutes on the resuscitation table was 30% and 17%, respectively. Median two healthcare providers were involved in the PO application. Video of the PO monitor signal was available in 118 (53%) of the 222 newborns. The proportion of time with a useful PO signal during ventilation and during the first ten minutes on the resuscitation table was 5% and 35%, respectively. Conclusion: In total, 97% of resuscitated newborns had PO applied, in line with resuscitation guidelines. However, the application of PO was time-consuming, and a PO signal was only obtained 5% of the time during positive pressure ventilation.
Language	English
Publishing date	2023-06-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children10071124
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Article: A Randomised Controlled Study of Low-Dose High-Frequency In-Situ Simulation Training to Improve Newborn Resuscitation.

Haynes, Joanna / Rettedal, Siren / Perlman, Jeffrey / Ersdal, Hege

Children (Basel, Switzerland)

2021 Volume 8, Issue 12

Abstract: Positive pressure ventilation of the non-breathing newborn is a critical and time-sensitive intervention, considered to be the cornerstone of resuscitation. Many healthcare providers working in delivery units in high-resource settings have little ... ...

Abstract	Positive pressure ventilation of the non-breathing newborn is a critical and time-sensitive intervention, considered to be the cornerstone of resuscitation. Many healthcare providers working in delivery units in high-resource settings have little opportunity to practise this skill in real life, affecting their performance when called upon to resuscitate a newborn. Low-dose, high-frequency simulation training has shown promise in low-resource settings, improving ventilation performance and changing practice in the clinical situation. We performed a randomised controlled study of low-dose, high-frequency simulation training for maintenance of ventilation competence in a multidisciplinary staff in a busy teaching hospital in Norway. We hypothesised that participants training according to a low-dose, high-frequency protocol would perform better than those training as they wished. Our results did not support this, although the majority of protocol participants were unable to achieve training targets. Subgroup analysis comparing no training to at least monthly training did identify a clear benefit to regular simulation practice. Simulated ventilation competence improved significantly for all participants over the course of the study. We conclude that frequent, short, simulation-based training can foster and maintain newborn ventilation skills in a multidisciplinary delivery unit staff in a high-resource setting.
Language	English
Publishing date	2021-12-02
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children8121115
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Article ; Online: Prevalence of bradycardia in 4876 newborns in the first minute after birth and association with positive pressure ventilation: a population-based cross-sectional study.

Rettedal, Siren / Kibsgaard, Amalie / Kvaløy, Jan Terje / Eilevstjønn, Joar / Ersdal, Hege Langli

Archives of disease in childhood. Fetal and neonatal edition

2023

Abstract: Objective: To determine the prevalence of bradycardia in the first minute after birth and association with positive pressure ventilation (PPV).: Method: A population-based cross-sectional study was conducted from June 2019 to December 2021 at ... ...

Abstract	Objective: To determine the prevalence of bradycardia in the first minute after birth and association with positive pressure ventilation (PPV). Method: A population-based cross-sectional study was conducted from June 2019 to December 2021 at Stavanger University Hospital, Norway. Parents consented to participation during pregnancy, and newborns ≥28 weeks' gestation were included at birth. Heart rate (HR) was captured immediately after birth and continuously for the first minute(s). Time of birth was registered on a tablet. Provision of PPV was captured using video. Results: Of 4876 included newborns, 164 (3.4%) did not breathe (two-thirds) or breathed ineffectively (one-third) and received PPV at birth. HR in the first minute had a wide distribution. The prevalence of first measured HR <100 and <60 beats/minute at median 16 s was 16.3% and 0.6%, respectively. HR increased in most cases. At 60 s, 3.7% had HR <100 beats/minute, of which 82% did not require PPV. In total, 25% of newborns had some registered HR <100 beats/minute during the first minute, of which 95% did not require PPV. Among newborns who received PPV, 76% and 62% had HR ≥100 beats/minute at 60 s and at start PPV, respectively. Conclusion: Bradycardia with HR <100 bpm in the first minute of life was frequent, but mostly self-resolved. Among the 4% of newborns that remained bradycardic at 60 s, only 20% received PPV. Two-thirds of resuscitated newborns had HR ≥100 beats/minute at start PPV. None of the ventilated newborns were breathing adequately at start PPV. Trial registration number: NCT03849781.
Language	English
Publishing date	2023-11-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2007331-8
ISSN	1468-2052 ; 1359-2998
ISSN (online)	1468-2052
ISSN	1359-2998
DOI	10.1136/archdischild-2023-325878
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Um IV Zs.106 -F.N.Ed.-: Show issues

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Article ; Online: Newborns requiring resuscitation: Two thirds have heart rate ≥100 beats/minute in the first minute after birth.

Kibsgaard, Amalie / Ersdal, Hege / Kvaløy, Jan Terje / Eilevstjønn, Joar / Rettedal, Siren

Acta paediatrica (Oslo, Norway : 1992)

2023 Volume 112, Issue 4, Page(s) 697–705

Abstract: Aim: The aim was to study the prevalence of bradycardia at birth in newborns requiring positive pressure ventilation (PPV), distribution of first measured heart rate (HR), changes in HR before start of PPV and HR response to PPV.: Methods: A ... ...

Abstract	Aim: The aim was to study the prevalence of bradycardia at birth in newborns requiring positive pressure ventilation (PPV), distribution of first measured heart rate (HR), changes in HR before start of PPV and HR response to PPV. Methods: A population-based study including newborns ≥30 weeks' gestation receiving PPV at birth. HR was captured immediately after birth and continuously throughout resuscitation using the dry-electrode ECG device NeoBeat. Time of birth was registered in the Liveborn app. Provision of PPV was captured by video. Results: We included 98 newborns receiving PPV at birth. Among newborns with HR measured within 60 s after birth, median (quartiles) first HR was 112 (84, 149) bpm recorded 19 (14, 37) s after birth, of which 33% had first HR <100 and 10% had first HR <60 bpm respectively. First HR was widely distributed. Median HR at start PPV 69 s after birth was 129 bpm. In newborns with an initial low HR, HR typically remained low for 20 s of PPV before increasing rapidly over the next 20-30 s. Conclusions: First measured HR was ≥100 bpm in two thirds of newborns receiving PPV. In bradycardic infants, HR did not increase until after 20 s of PPV.
MeSH term(s)	Infant ; Female ; Infant, Newborn ; Humans ; Heart Rate/physiology ; Resuscitation ; Positive-Pressure Respiration ; Intermittent Positive-Pressure Ventilation ; Bradycardia
Language	English
Publishing date	2023-01-21
Publishing country	Norway
Document type	Journal Article
ZDB-ID	203487-6
ISSN	1651-2227 ; 0365-1436 ; 0803-5253
ISSN (online)	1651-2227
ISSN	0365-1436 ; 0803-5253
DOI	10.1111/apa.16659
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Article ; Online: Comparison of Performance Score for Female and Male Residents in General Surgery Doing Supervised Real-Life Laparoscopic Appendectomy: Is There a Norse Shield-Maiden Effect?

Skjold-Ødegaard, Benedicte / Ersdal, Hege Langli / Assmus, Jörg / Soreide, Kjetil

World journal of surgery

2021 Volume 45, Issue 4, Page(s) 997–1005

Abstract: Background: Gender bias may represent a threat to resident assessment during surgical training, and there have been concerns that women might be disadvantaged. There is a lack of studies investigating gender differences in 'entry-level' real-life ... ...

Abstract	Background: Gender bias may represent a threat to resident assessment during surgical training, and there have been concerns that women might be disadvantaged. There is a lack of studies investigating gender differences in 'entry-level' real-life procedures, such as laparoscopic appendectomy. We aimed to explore potential gender disparities in self-evaluation and faculty evaluation of a basic surgical procedure performed by junior surgical residents in general surgery. Methods: A structured training program in laparoscopic appendectomy was implemented before undertaking evaluation of real-life consecutive laparoscopic appendectomies by junior residents in general surgery. Resident and faculty gender-pairs were assessed. Intraclass correlation coefficient (ICC) was calculated using a single-rater, consistency, 2-way mixed-effects model. Results: A total of 165 paired sessions were completed to evaluate resident-faculty scores for the procedure. Overall, 19 residents participated (43% women) and 26 faculty (42% women) were involved. The overall correlation between faculty and residents was good (ICC > 0.8). The female-female pairs scored higher for most steps, achieving excellent (ICC ≥ 0.9) for several steps and for overall performance. Female residents were more likely to give a higher self-evaluated score on own performance particularly if evaluated by a female faculty. Also, female trainees had highest correlation-score with male faculty. Conclusions: This study found higher performance scores in female surgical residents evaluated during real-time laparoscopic appendectomy. No negative gender bias toward women was demonstrated. Better insight into the dynamics of gender-based interaction and dynamics in both training, feedback and influence on evaluation during training is needed when evaluating surgical training programs.
MeSH term(s)	Appendectomy ; Clinical Competence ; Female ; General Surgery/education ; Humans ; Internship and Residency ; Laparoscopy ; Male ; Sexism
Language	English
Publishing date	2021-01-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-020-05921-4
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