Choosing High-Fidelity Infant Simulators Based on the Neonatal Resuscitation Process

In emergency medicine, there is a widely accepted principle: any life-saving intervention should be initiated as early as possible.
Therefore, the ability to make prompt, accurate on-site assessments and clinical decisions is crucial. If the initial steps of an emergency response are delayed, the overall effectiveness of the intervention may be significantly compromised.

This concept is equally applicable in neonatal resuscitation.
The primary goal is to ensure that the newborn receives adequate oxygen. If hypoxia occurs, it can quickly lead to myocardial oxygen deprivation, resulting in bradycardia, decreased muscle tone, poor organ perfusion, and even organ failure. Thus, the critical first step in neonatal resuscitation is to identify any signs of respiratory distress and promptly provide respiratory support.

Clinically, evaluating a newborn's respiratory function involves observing whether the baby is crying, checking for regular chest and abdominal movement, and noting any signs of labored breathing such as chest retractions or nasal flaring. Once respiratory distress is identified, resuscitation procedures should begin immediately. These include basic interventions like warming, stimulation, and clearing airway obstructions (e.g., meconium or amniotic fluid), followed by the application of Continuous Positive Airway Pressure (CPAP) to help open the alveoli.

If these initial steps fail to improve breathing and the heart rate continues to decline, more advanced interventions may be necessary—such as Positive Pressure Ventilation (PPV), intubation, medication administration, and chest compressions.

With this framework in mind, the selection of neonatal manikins for simulation training should prioritize the accurate representation of key symptoms of respiratory distress. This includes weak or absent breathing, visible signs of labored respiration such as chest retractions and nasal flaring, abnormal breath sounds linked to alveolar collapse, reduced limb tone, cyanosis of the face due to hypoxia, and decreasing heart rate.

On top of these essential features, further considerations include whether the simulator supports intubation, umbilical venous catheter placement, realistic chest compression with real-time CPR quality feedback, and detection of over-ventilation—an especially critical feature given the fragility of neonatal alveoli.
Additional features like the ability to display jaundice or seizure activity could also be beneficial.

For training scenarios involving prolonged incubator care or neonatal transport, it may be appropriate to consider high-fidelity infant simulators that can interface with clinical equipment such as pulse oximeters and ventilators. Advanced simulators should ideally support multiple respiratory support modes (e.g., Pressure-Controlled Assist-Control, PC-AC) to facilitate more refined respiratory management training.