{"doi":"10.1001/jamanetworkopen.2024.60565","title":"Essential Newborn Care Virtual Simulations for Skills Retention in Newborn Care","abstract":"Importance: Newborn mortality accounts for approximately 47% of all mortality of children under the age of 5 years. Virtual simulation may be a viable approach to support retention of essential newborn care knowledge and skills among health care professionals in low- and middle-income countries. Objective: To evaluate the association between mobile virtual simulation using Virtual Essential Newborn Care (vENC) and knowledge and skills retention in early newborn care in low-resource settings and to propose a frequency of virtual simulation use for among health care professionals who care for newborns in low-resource settings. Design, Setting, and Participants: This cohort study was conducted at 23 primary, secondary, and tertiary health care facilities in Lagos, Nigeria, for 6 months between December 1, 2022, and June 30, 2023. Participants included nurses and midwives who participated in deliveries and provided newborn care. Potential participants who attended a Helping Babies Breathe or Essential Newborn Care (ENC) course within the past 1 year were excluded. Exposures: All participants received in-person training using the World Health Organization ENC 1 and ENC 2 curricula along with virtual simulation practice at variable recommended frequencies for 6 months after course completion. Main Outcomes and Measures: Primary outcomes included assessments of bag-valve-mask (BVM) ventilation skills, and performance on ENC 1 and ENC 2 case A and B scenarios conducted by trained research assistants before, immediately after, and 6 months after the in-person course. All scores ranged from 0% to 100%, with higher scores indicating better performance. Results: Of 70 enrolled participants (67 of 69 [97%] female), 62 (89%) completed the 6-month follow-up. Immediate posttraining performance (median [IQR] scores: BVM ventilation skills, 93% [86%-100%]; ENC 1 case scenario A, 72% [61%-78%]; ENC 1 case scenario B, 76% [68%-88%]; ENC 2 case scenario A, 80% [73%-87%]; and ENC 2 case scenario B, 88% [70%-95%]) improved compared with pretraining performance for all skill assessments (median [IQR] scores: BVM ventilation skills, 57% [29%-64%]; ENC 1 case scenario A, 39% [28%-50%]); ENC 2 case scenario A, 33% [20%-45%]) (all P < .001). There were further gains in performance at the 6-month follow-up assessment for BVM ventilation (median [IQR], 100% [86%-100%]; P = .04) and the ENC1 and ENC2 assessments by case scenario (case scenario A: ENC 1 median [IQR] score, 78% [72%-83%]; P = .001 and ENC 2 median [IQR] score, 87% [80%-93%]; P = .008; and case scenario B: ENC 1 median [IQR] score, 88% [76%-92%]; P = .009 and ENC 2 median [IQR] score, 93% [80%-100%]; P = .004) relative to the immediate postcourse assessment scores. Conclusions and Relevance: Findings of this cohort study suggest that the app-based simulations may be effective in supporting the retention of knowledge and skills following ENC training and may contribute to further performance gains for health care professionals in low- and middle-income countries. More clinical and implementation research is needed to explore the impact of virtual simulations on health professionals' clinical practices and neonatal outcomes.","journal":"JAMA Network Open","year":2025,"id":517935,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":7,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9585,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":638414,"name":"Chinyere Ezeaka","orcid":"0000-0003-1880-4616","position":1,"is_corresponding":false},{"id":695240,"name":"Sara K. Berkelhamer","orcid":"0000-0001-8301-2290","position":2,"is_corresponding":false},{"id":420625,"name":"Daniel S. Hippe","orcid":"0000-0003-2427-4404","position":3,"is_corresponding":false},{"id":1384897,"name":"Ime Asangansi","orcid":"0000-0002-0582-2455","position":4,"is_corresponding":false},{"id":1385374,"name":"Matthew W. Cook","orcid":null,"position":5,"is_corresponding":false},{"id":1384898,"name":"Iretiola Fajolu","orcid":"0000-0003-3045-9616","position":6,"is_corresponding":false},{"id":1384899,"name":"Olubukola Olawuyi","orcid":"0000-0003-3782-4735","position":7,"is_corresponding":false},{"id":1385375,"name":"Christianah O Adeboboye","orcid":null,"position":8,"is_corresponding":false},{"id":1385376,"name":"Oluwadamilola O. Ekhalufoh","orcid":null,"position":9,"is_corresponding":false},{"id":1385377,"name":"Omolola S. Fashola","orcid":null,"position":10,"is_corresponding":false},{"id":696043,"name":"John Feltner","orcid":null,"position":11,"is_corresponding":false},{"id":1385378,"name":"Joseph Fisher","orcid":null,"position":12,"is_corresponding":false},{"id":1384900,"name":"Jasmine James","orcid":"0000-0001-9907-906X","position":13,"is_corresponding":false},{"id":1385379,"name":"Olukemi M. Imoukhuede","orcid":null,"position":14,"is_corresponding":false},{"id":1385380,"name":"Nahee Park","orcid":null,"position":15,"is_corresponding":false},{"id":1385381,"name":"Victoria Quach","orcid":null,"position":16,"is_corresponding":false},{"id":1385382,"name":"Amanda K. Stiffler","orcid":null,"position":17,"is_corresponding":false},{"id":609230,"name":"Cyril Engmann","orcid":null,"position":18,"is_corresponding":false},{"id":1107781,"name":"Rachel Umoren","orcid":"0000-0003-2356-9278","position":0,"is_corresponding":true}],"reference_count":30,"raw_metadata":null,"created_at":"2026-07-19T02:49:04.756302Z","pmid":"39976968","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}