The first few weeks of life are tenuous, especially if the infant is born prematurely. In many cases, preterm newborns require additional care, including neonatal resuscitation. Neonatal resuscitation is a series of steps that aim to help infants breathe independently and maximize their chance of survival. Performing these steps requires specialized training, and according to a recent study, this training can be provided through virtual reality.
VR technologies utilize computer modeling and 3D simulations to transport users to different places even though their physical location does not change. These technologies are increasingly used in healthcare for pain management, mental healthcare and physician therapy, among other use cases. For instance, earlier this year, Cedars-Sinai investigators announced that they had created a VR app that offers conversational therapy in relaxing virtual environments.
VR is also being used in healthcare provider training. An initiative launched earlier this year aims to use VR to educate physicians on implicit bias, teach cultural competency skills and improve physician-patient communication.
Now, a team of researchers from Altru Hospital in Grand Forks, N.D., and the University of Wisconsin School of Medicine and Public Health in Madison has found that VR-based training for neonatal resuscitation is not only feasible but also popular among neonatal providers.
What is neonatal resuscitation?
Preterm births are those that occur before 37 weeks of pregnancy have been completed. In the United States, the preterm birth rate was 10.4% in 2022, according to the latest data from the Centers for Disease Control and Prevention.
Preterm infants face numerous health risks, including feeding difficulties, hearing problems and difficulties breathing on their own. These infants require varying levels of support depending on how preterm they are.
For instance, while many infants born at 22 weeks might need to be intubated and placed on ventilator support, a smaller subset might need chest compressions or cardiac support at delivery, explained Ryan McAdams, M.D., professor in the Division of Neonatology and Newborn Nursery and a member of the Division of Global Pediatrics at the University of Wisconsin School of Medicine and Public Health.
Thus, an effective neonatal resuscitation protocol is necessary to ensure that preterm babies have the support they need to survive.
"This can't be chaotic," McAdams said in an interview. "We need to follow a specific evidence-based or expert-advised algorithm in order to properly resuscitate these babies; in order to say, we did these things in the way that the evidence supports, and we did it in a timely manner, in an organized fashion, and that's going to give that baby the best chance for a good outcome."
The American Academy of Pediatrics created the Neonatal Resuscitation Program in the 1980s to provide an evidence-based approach to care for at-risk newborns. Now in its eighth iteration, the program teaches various skills, such as inserting and removing laryngeal masks, performing cardiac compressions and endotracheal intubation and providing positive-pressure ventilation using a PPV device and a face mask.
Though the training program is effective, it is typically conducted using mannequins, which differs from the real-life experience of providing neonatal resuscitation, according to McAdams.
"It's still pretty lacking," he said. "Even if I get one of these $7,000 mannequins so it can move its arms a little bit, it can make a noise; it can cry, its cheek can turn blue to show its oxygen level isn't good -- it's still very far from reality. ... So, how do you solidify that knowledge, and how do you make that experience memorable so that you really understand it and learn it, and then you can apply it?"
Benefits of VR training for neonatal resuscitation
According to McAdams, VR technologies can significantly enhance neonatal resuscitation training by providing an element of realism and offering trainees an immersive experience.
"I experimented with some VR platforms, and I said, 'It has a role in affecting me as I'm experiencing it. I'm in the environment. Why don't we apply this to what I'm doing on resuscitating babies?'"
I experimented with some VR platforms, and I said, 'It has a role in affecting me as I'm experiencing it. I'm in the environment. Why don't we apply this to what I'm doing on resuscitating babies?'
Ryan McAdams, M.D.Professor and Division of Global Pediatrics member at the University of Wisconsin School of Medicine and Public Health
McAdams, along with GiaKhanh Sarah Trinh, M.D., a neonatologist at Altru Hospital, worked with Arch Virtual to create a VR simulation model. Using the company's Acadicus simulation platform and 3D models of the resuscitation and delivery rooms, the development team created a VR simulation model wherein the trainee can interact with an infant born at 30 weeks in a realistic environment. The goal was to make the simulation as close to real life as possible.
"The baby needs to be able to move and breathe and cry and have different capabilities for respiratory distress," McAdams said. "I need to be able to listen to its heart rate. I need to hear lung sounds. It needs to look like a real baby, too. This was an iterative process to continue to develop the model to get it to look real life."
Not only that, but McAdams also recorded various sounds from the labor and delivery rooms, like alarms and beeps from multiple machines, to ensure that the auditory stimuli within the VR environment were accurate.
The team then designed a low-complexity case for the VR platform to demonstrate the MR. SOPA protocol for ventilation in the Neonatal Resuscitation Program. MR. SOPA stands for Mask adjustment, Repositioning the airway, Suction mouth and nose, Opening the mouth, Pressure increase, and Airway alternative.
After creating the VR model and training scenario, the team had people test it, incorporating their feedback.
"They may say, 'Oh, it's a little hard to move the baby's head.' And so, then we would have to work with our designers and say, let's try and correct that," McAdams said.
The development of the VR simulation training model from conception to prototype took about four years. Following this, McAdams and Trinh conducted a study to examine its feasibility and whether clinicians would find the VR-based training acceptable. They published the results in the Journal of Perinatology.
The study included 38 neonatal providers who completed the training and responded to post-training surveys. The results showed that the VR-based training was popular among the providers, with 97% expressing willingness to reuse the VR simulation model and 95% saying they would recommend it to colleagues. Additionally, 70.3% of participants found the VR experience to be more realistic than traditional training methods.
"This pilot study highlights VR's potential to enhance neonatal resuscitation training through increased realism and adaptability," the researchers concluded.
Next steps to advance VR-based training
Though the enthusiasm for the VR simulation was high, neonatal providers participating in the study also reported some physical challenges to VR use. About 40.5% of survey respondents reported VR-related symptoms, the most common being eye strain (21.6%), followed by motion sickness (18.9%).
However, McAdams noted that the magnitude of VR-related symptoms is unclear.
"We didn't check to see how long it lasted," he said. "And my guess is it was pretty short-lived. ... That's something we need to focus on, work on. Probably study a little bit better to say, how much of a problem is that really? And if you use [VR] more, does that just go away?"
Further, only 29% of survey respondents said they had used VR previously, and only one participant owned a VR headset. Thus, the training includes a tutorial to help familiarize trainees with the technology.
"They learn how to use the hand controllers, how to teleport, how to move around -- a familiarity component that is really important," McAdams explained.
Though VR technology has limitations in terms of haptic realism, the researchers believe that the VR model could boost knowledge retention by effectively immersing the user in a realistic simulation of a clinical environment.
As VR continues to evolve, McAdams also hopes that the technology will allow for more diversity in training.
"I could say I want the mom to be Chinese," he said. "I want her to be from Ghana. I want her to be Hispanic. I want her to be white. I want her to be Black. I want her partner to be another woman. Really endless variability with the players involved."
Several unknowns remain in the effort to make VR-based training more common in the healthcare industry, such as funding and access to the necessary IT infrastructure; however, the potential to improve neonatal resuscitation training is vast, making it an exciting new prospect for clinical educators.
"It's an uncomfortable environment, but it's a great environment to learn in and would hopefully prepare [trainees] for the real thing," McAdams said.
Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.
