Assessment of adherence to the neonatal resuscitation program using video recording: a prospective observational study.

Background: Although evidence-based guidelines from the Neonatal Resuscitation Program (NRP) are widely used, adherence to the NRP algorithm remains inconsistent across healthcare settings. This study aimed to assess adherence to the NRP algorithm using video recording. Methods: A prospective observational study was conducted at a university hospital in Bangkok, Thailand. Video recordings of resuscitations for high-risk deliveries, attended by pediatric residents and neonatal fellows, were reviewed from February 2023 to January 2024. Adherence was evaluated using a specified assessment form for procedural steps and techniques according to the 8th edition of the NRP algorithm published by the American Academy of Pediatrics. Results: Out of 498 video-recorded resuscitations, common deviations during basic resuscitation included overstimulation (53.4 %), excessive suctioning (14.7 %), and inadequate heat loss prevention for preterm neonates ≤32 weeks' gestation (30.6 %). For positive pressure ventilation, common deviations included inconsistent face mask seal (16.9 %), improper finger positioning with the C-E technique (12.3 %), and incorrect ventilation rate (12.3 %). Among 34 intubation attempts, the success rate of the first-attempt intubation was 41.2 %, and prolonged intubation (lasting more than 30 s) occurred in 61.8 %. Conclusions: This study demonstrated that video recordings effectively identified several deviations from the NRP algorithm, offering insights into areas for improvement. These recordings may serve as a valuable supplementary tool for NRP training.