1. ALERT Presentation:
Improving neonatal resuscitation
using a virtual interactive trainer
Judy LeFlore, JoDee Anderson, Myra
Wyckoff, Taylor Sawyer, Lindsay Johnston,
Susan Niermeyer, Akira Nishisaki, Kathleen
Ventre, Marge Zielke

2. Background
• Airway management continues to be the leading
challenge to neonatal patient survival and safety because
endotracheal intubation skills are not easily taught.
• Proficiency in safe and successful endotracheal tube
placement improves with experience
• Inability to recognize key landmarks for successful
endotracheal intubation is the most significant failure
point.
• There is evidence that gaming and virtual reality in health
care education increases knowledge acquisition and
facilitates skill acquisition and transfer to clinical
practice.

3. PICO Question
• Population
– Healthcare providers that have newborn resuscitation
opportunities
• NNPs
• Pediatric residents
• Respiratory therapists
• Paramedics
• Intervention
– Neonatal Interactive Virtual Airway Trainer (NIVAT)
• Comparison
– Power point presentation
• Outcome
– Intubation success in the clinical setting will be
greater for the NIVAT intervention group than for the
PP intervention group

4. Approach
• 3-Phase study (Design over 3 years)
1. Phase I: Development Phase
1. Develop NIVAT, Proficiency assessment, PPT
2. Rater reliability
3. Recruit/randomize
1. Benchmark proficiency (#1)
2. Orient to intervention, study protocol, introduce journals
4. Participants keep journals during remainder of Dev Phase
2. Phase 2: Intervention Phase
1. Collect journals (#1)
2. Proficiency assessment (#2)
3. Intervention
3. Phase 3: Degradation Phase
1. Collect journals (#2)
2. Proficiency assessment (#3)
3. Data analysis

5. Develop Phase (1 year) Intervention Phase Begins
1. NIVAT 1. Collect journals (#1)
2. PPT 2. Proficiency assessment (#2)
3. Proficiency assessment tool 3. NIVAT or PPT Group
Intervention
4..Recruit
5. Randomize
6. Rater reliability
Decay Phase
7. Benchmark Proficiency (#1),
1. Collect journals (#2)
8.Orient to intervention, study
2. Proficiency assessment (#3)
protocol, and journal.
3. Data analysis
9 Study participants keep
journals during Development
Phase

6. 3 Questions
• HOW DO WE:
– To calculate adequately power for the study, what should be
used to calculate effect size?
– 30second from AAP
– Success on first or second try 80% of time?
– Where to recruit from now the GME no longer requires
intubation as a competency. Will program directors think this
study is important? How do we promote participants adherence
to monthly NIVAT or PPT. Should we try different exposure times
to assess “Dose effect”? Reliability of keeping accurate journals
r/t intubation opportunities throughout the study?
– Recruit research assistants committed to completing proficiency
assessments when indicated