Essential Newborn Care Virtual Simulations for Skills Retention in Newborn Care
Authors: Rachel A. Umoren, Chinyere Ezeaka, Sara K. Berkelhamer, Daniel S. Hippe, Ime E. Asangansi, Matthew W. Cook, Iretiola B. Fajolu, Olubukola Olawuyi, Christianah Adeboboye, Oluwadamilola O. Ekhalufoh, Omolola S. Fashola, John Feltner, Joseph D. Fisher, Jasmine M. James, Olukemi M. Imoukhuede, Nahee Park, Victoria Quach, Amanda K. Stiffler, Cyril M. Engmann
Journal: JAMA Network Open (2025)

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 &amp;amp;lt; .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.