A NEST Program simulation training

The NEST Program provides hands-on, simulation-based training in neonatal intubation and resuscitation techniques for pediatric providers across the region.

All new parents hope for a healthy delivery, but in the rare instance that an unexpected medical issue arises as baby enters the world, it’s crucial that the newborn delivery and transport care teams are well versed in performing neonatal emergency procedures.

Breathing difficulties are some of the most frequent unexpected medical issues in newborns, especially in preemies. According to Seattle Children’s neonatologist, Dr. Taylor Sawyer, about 10% of all babies born in the U.S. will need breathing assistance in the delivery room, and about 1 in 1,000 will need to be intubated, or have a tube urgently inserted in their airway to push air into their lungs. Fortunately, these emergency situations are uncommon. However, this infrequency can leave many delivery providers and transport teams in the community, who only intubate a newborn about once a year, feeling out of practice and a bit uneasy when required to perform this complex task.

This is why Seattle Children’s and the University of Washington have launched the Neonatal Education and Simulation-based Training (NEST) Program, which offers hands-on, simulation-based training in neonatal intubation and resuscitation techniques for pediatricians, nurses and transport team members across the region.

Sawyer, who is a co-director of the NEST Program, said pediatric providers in the community were asking for this type of training and they felt it was important to address this unmet need.

“Emergency procedures like intubation, which has to be completed within about 30 seconds, are challenging to perform on a newborn because of their small, delicate anatomies; leaving an incredibly small margin for error,” Sawyer said. “As leaders in neonatal care with state-of-the-art simulation technology, we have a unique opportunity to help improve patient care across the region by offering education that enables pediatric providers to feel comfortable performing low frequency, high risk procedures. After all, practice makes perfect.”

Neonatal education takes flight across the region

To date, the NEST Program has brought simulation training to pediatricians, nurses and transport team members in Olympia, Mt. Vernon, Tacoma and Everett, and has plans over the next year to expand the training to Montana and the Tri-Cities.

Dr. Sawyer (center) leading a NEST Program simulation training

Dr. Sawyer (center) leading a NEST Program simulation training

During training sessions, the NEST Program team brings high-tech mannequins that are able to emulate a newborn by registering the action that the team is performing and responding with physical cues. For example, the lifelike mannequins can turn blue if they’re not getting air, providers can feel their pulse and they can even cry. In addition to intubation, some of the other procedures practiced in sessions include neonatal resuscitation, vascular access techniques and needle thoracentesis.

When the simulation mannequins are not traveling around the region, they are used at Seattle Children’s and UW for group education sessions. A variety of providers also use them to practice and sharpen their skills before certain procedures, including providers from neonatal intensive care, anesthesia and otolaryngology. Simulation training is also provided on a regular basis to residents and nursing students.

“It’s important to be able to provide this type of hands-on training to newer doctors and nurses so that by the time they have to perform difficult procedures on a real patient, they’re confident and feel like they’ve done it many times,” said Dr. Craig Jackson, medical director of Seattle Children’s neonatal intensive care unit, who leads training sessions at Seattle Children’s. “We’re lucky that we have this excellent simulation technology at our fingertips that makes the training much more realistic.”

A bird’s-eye view on best practices

In addition to education, another area of focus for the NEST Program is research. One current research project aims to determine which neonatal mannequins on the market are most realistic and effective for airway skills training. The NEST Program is also working to examine the best methods for administering chest compressions during neonatal resuscitation, including evaluations of the frequency of compressions and the position of the body of the person providing compressions. The research, which is performed on computer controlled mannequins, has the potential to change the standard of care.

“We want to not only teach, but also identify the best tools for training and the best processes for performing vital procedures that save lives,” said Sawyer.

Sawyer said that the response to the program has been very positive and he feels the NEST Program has a bright future ahead.

“We’re thrilled with the success we’ve had and we hope to continue to grow the program so that we can reach even more pediatric providers in their communities, empowering them to be able to deliver the highest level of patient care, even in the most difficult situations,” said Sawyer.