Low-dose, high-frequency simulation with respiratory function monitor feedback enhances face mask ventilation across neonatal resuscitation devices: A prospective study in neonatology fellows

Face mask ventilation (FMV) is a critical skill in neonatal resuscitation, yet structured assessment of neonatology fellow competence has remained limited. This study evaluated whether low-dose, high-frequency simulation with real-time respiratory function monitor (RFM) feedback improved FMV performance across commonly used ventilation devices. A prospective, single-center study was conducted over nine months involving neonatology fellows who performed simulated FMV using a T-piece resuscitator, self-inflating bag, and flow-inflating bag. Each session included blinded and unblinded RFM conditions. Primary outcomes included tidal volume (TV) within target range, mask leak, peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), respiratory rate, and self-reported proficiency. Mixed-effects models accounted for repeated measures. TV within goal range was higher with RFM feedback (80.3% vs 62.3%, p<0.0001) and mask leak was lower with feedback across all three devices. No independent effect of feedback was observed for PIP or respiratory rate. Increasing session number improved respiratory rate, PIP, and PEEP but did not significantly improve TV or mask leak, suggesting limited skill improvement without feedback. Performance varied by device modestly, but higher performance was associated with RFM feedback and practice sessions across all devices. Self-reported confidence improved significantly across all devices, though clinical FMV frequency did not change. These findings support the use of RFMs in neonatal training regardless of device type while highlighting the need for strategies to improve long-term skill retention.