The power of practice: improving neonatal resuscitation in India

Worldwide, nearly half of deaths of children under five occur in the first month of life. The rate is even higher in India. Despite the rise in neonatal resuscitation (NR) training programs, there is little known about their impact on providers with limited medical education, especially those working in rural areas.

A new paper evaluates the impact of PRONTO International simulation training on NR skills in primary health centers in Bihar, India, in both simulations and live deliveries. Skills including proper neck extension, positive pressure ventilation (PPV) with chest rise and assessment of heart rate all improved from week 4 to week 8 of training. In live deliveries, researchers found improvements in identification of non-vigorous newborns, use of PPV and use of suction.

However, interviews revealed individual, logistical and cultural barriers to implementing NR skills. Those barriers included issues like not knowing how to measure vital signs or not knowing how to read a clock to measure them; losing time because of the traditional practice of waiting for newborns to cry; and the lack of availability of essential equipment like different mask sizes.

The PRONTO training had a positive impact on knowledge and use of evidence-based practices in Bihar. Further improvements will need to be made to address the barriers identified by researchers and continue to achieve better health outcomes for infants.