Background: Previous studies on Neonatal Resuscitation Program® (NRP) training show that even with intensive simulation-based training to a mastery standard, the majority of NRP providers fail to maintain performance at 6 months. However the gaps in adherence to the NRP algorithm following an NRP provider course are unknown. Objectives: To identify common gaps in performance of the steps of neonatal resuscitation on a standardized simulation immediately after an NRP course. Method: From January 2016-December 2018, neonatal care providers with and without previous NRP provider training were recruited at 4 U.S. institutions as part of the eSim study, an evaluation of the impact of computer-based NRP training on NRP skills. According to current NRP standards, each participant completed the required pre-work including two eSIM scenarios and the on-line NRP exam before attending an in-person provider course. Immediately after the course, participants completed a standardized NRP simulation as the team leader with trained facilitators as team members. NRP performance was evaluated in real-time for a subset of NRP steps and by video review using a checklist. If an NRP skill was not done or took place out of sequence, it was scored as incorrect. Data were reported using descriptive statistics. Results: 167 neonatal care providers participated. See Table 1 for participant demographics. Reviewer interrater reliability was high, Cronbach alpha = 0.96 (95% CI, 0.94-0.98). Nearly all providers directed initial steps of resuscitation and requested that a pulse oximeter probe be placed before intubation. However, less than half of providers led a team briefing with role assignments and what to expect, correctly assessed endotracheal tube placement, or increased oxygen concentration to 100% before starting chest compressions. Areas of high adherence and poor adherence to the NRP algorithm are shown in Figure 1. Conclusion: Significant deviations from recommended sequence of the NRP algorithm were noted in provider performance immediately after completing an NRP course. This supports the need for increased attention to these areas during training and the inclusion of mastery training requirements in NRP courses. Acknowledgements: The study was supported by the American Academy of Pediatrics.

Table 1

Demographics of study participants

Table 1

Demographics of study participants

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Figure 1

Neonatal Provider Adherence to Neonatal Resuscitation Program Algorithm

Figure 1

Neonatal Provider Adherence to Neonatal Resuscitation Program Algorithm

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