Feasibility of Implementing Resuscitation Training for Parents of At-risk Infants at Discharge (FIRST AID).

Abstract

Introduction: Neonatal intensive care unit (NICU) graduates are at risk of sudden death at home after discharge. Many of these deaths can be prevented if parents can identify warning signs and provide immediate resuscitation.

Objectives: The primary objective of this study was to assess the feasibility of training parents of high-risk neonates in low- and middle-income countries (LMICs) to deliver infant resuscitation effectively. The secondary objectives were to assess the parental anxiety and need for resuscitation at the end of one month after discharge.

Methods: This prospective study was conducted in a tertiary care teaching hospital. After consent, parents of infants <34 weeks gestation, weighing < 1500 grams at birth, or with neurological abnormalities at discharge were trained in a modified version of basic newborn resuscitation using a low-fidelity mannequin and self-inflating bag by a trained neonatal fellow. Resuscitation skills were evaluated using a post-training assessment score sheet. A total score of 75% with four mandatory steps was considered pass; the parent was re-trained until they passed the evaluation. Anxiety levels of the parent were assessed one month after discharge using the General Anxiety Disorder 7 (GAD 7) scale, and the need for resuscitation was documented.

Results: Between June 2020 to July 2021, a total of 91 parents of high-risk newborns were trained in infant resuscitation. The mean gestational age and birth weight of neonates were 30 (2) weeks and 1315 (349) grams, respectively. 80% of the trained parents passed on the first attempt, and 18% passed on the second attempt. The mean (SD) time required to train each parent was 22 (4) minutes. One-month post-discharge, one mother reported mild anxiety, and skills were used to resuscitate one infant.

Conclusion: Parents of high-risk neonates at LMICs can be trained to deliver effective cardiopulmonary resuscitation before discharge using low-fidelity simulators without increasing parental anxiety.