Umbilical cord clamping management may affect cerebral oxygenation (rSO2C), but previous studies have only investigated effects in the first minutes of life. Our objective was to determine whether delayed cord clamping (DCC) and umbilical cord milking (UCM) differently affect cerebral oxygenation and cardiovascular function in the first 24 h of life in preterm infants. A post-hoc secondary outcome analysis of a multicentre prospective randomised clinical trial (PCI), conducted between April 2016 and February 2023 at 8 Italian neonatal intensive care units. The present ancillary study included preterm infants with 23+0–29+6 30 weeks’ gestation. One hundred and five infants received DCC and 104 UCM during resuscitation. Cerebral regional tissue oxygenation (rSO2C) was measured by near-infrared spectroscopy (NIRS) at 3 (T3h), 6 (T6h), 12 (T12h), 18 (T18h), and 24 (T24h) hours of life. Cardiovascular function was assessed by echocardiography within the first 24 h of life. We found that rSO2C was higher at T3h [79 (76–84) vs. 78

Background: Data on surfactant retreatment in preterm infants with respiratory distress syndrome (RDS) are limited, and international guidelines do not provide specific recommendations on this issue. The objective of this study was to evaluate the effectiveness of surfactant retreatment in very preterm infants (VPI). Methods: We retrospectively studied 140 VPI born at 23+0-29+6 weeks of gestation from January 2018 to June 2024 requiring surfactant treatment. Peripheral oxygen saturation/fraction of inspired oxygen (SpO2/FiO2) and arterial/alveolar partial pressure of oxygen (a/APO2) ratios were calculated prior to and following administration of the first and second doses of surfactant. Demographic and clinical features of infants receiving a single dose were compared with those of infants requiring multiple doses. Results: Fifty-four (39%) infants received one dose of surfactant and 86 (61%) multiple doses. SpO2/FiO2 and a/APO2 ratios improved significantly after administration of both the first and second doses of surfactant. Logistic regression analysis demonstrated that the SpO2/FiO2 ratio before the first dose of surfactant (odds ratio 0.994, 95% CI: 0.989-0.999, P=0.047) was inversely correlated with the need for a second dose of surfactant. Conclusions: The first and second doses of surfactant were effective in improving SpO2/FiO2 and a/APO2 ratios in VPI with RDS. Low SpO2/FiO2 ratios prior to the first surfactant dose may identify infants likely to require multiple surfactant doses. These results support the importance of further studies aimed at standardizing the treatment with multiple doses of surfactant.

BACKGROUND:Fetal hemoglobin (HbF) plays a critical role in the progressive adaptation to the postnatal oxygen-rich environment in preterm infants due to its peculiar properties and its postnatal decrease has been associated to the combined adverse effects of increasing tissue hyperoxia and decreasing antioxidant defenses in preterm infants. PURPOSE:We aimed to assess the association between HbF fractions and the risk of bronchopulmonary dysplasia (BPD) intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP). METHODS:We studied 166 preterm infants with a gestational age of 27.1 ± 1.6 weeks. One hundred and twenty-six infants (74%) had no or mild BPD, and 40 (24%) moderate to severe BPD. One hundred and forty-three infants (86%) had no or grade 1 IVH, and 23 (14%) grade 2-4 IVH. One hundred and thirty (80%) had no ROP, and 32 (20%) had any grade ROP. HbF fractions were recorded during the first seven days of life, at 14, 21, and 28 days of life, and 31, 34, and 36 weeks of postmenstrual age. Mean values during the first week of life (HbF1st week) and at 31, 34, and 36 weeks (HbF31-36 weeks) were calculated. RESULTS:Logistic regression analysis showed that: HbF31-36 weeks decreased the risk of moderate to severe BPD (OR 0.944, 95% CI 0.911-0.977; p = 0.001); female sex (OR 0.278, 95% CI 0.093-0.832; p = 0.022) and HbF1st week (OR 0.949, 95% CI 0.901-0.999; p = 0.048) decreased the risk of grade 2-4 IVH; and HbF1st week (OR 0.958, 95% Cl 0.919-0.998; p = 0.042) and HbF31-36 weeks (OR 0.956, 95% CI 0.927-0.986; p = 0.004) decreased the risk of any grade ROP. CONCLUSION:Low HbF fractions were associated with increased risk of moderate-to severe BPD, grade 2-4 IVH, and any grade ROP. These results confirm previous findings and support the importance of minimizing blood sampling from these fragile patients.

Importance:Despite continuous improvements in neonatal resuscitation and stabilization in the last decades, thermal management immediately after birth remains an unresolved issue in preterm infants. Objective:To compare 2 strategies of thermal management (plastic wrapping with or without drying) for preventing heat loss at birth in very preterm infants. Design, Setting, and Participants:This multicenter, unblinded, randomized clinical trial was conducted among very preterm infants (birth weight <1500 g and/or gestational age ≤30 weeks 6 days) at 21 tertiary care hospitals in Italy from February 21, 2023, to July 18, 2024. Interventions:Eligible neonates were randomly allocated to either drying before plastic wrapping in the delivery room (intervention arm) or plastic wrapping without drying (control arm). Main Outcomes and Measures:The primary outcome was the proportion of participants with normothermia (36.5-37.5 °C) at admission to the neonatal intensive care unit (NICU). The secondary outcomes included hypothermia (<36.5 °C), moderate to severe hypothermia (<36.0 °C), and hyperthermia (>37.5 °C) at NICU admission, temperature at 1 hour after NICU admission, intraventricular hemorrhage, respiratory distress syndrome, late-onset sepsis, bronchopulmonary dysplasia, and mortality before hospital discharge. Results:Overall, 354 very preterm infants were randomized (180 [50.8%] female; mean [SD] gestational age, 28.6 [2.5] weeks); all received the allocated intervention and were included in the analysis. Normothermia at NICU admission was achieved in 81 of 177 dried infants (45.8%) and 82 of 177 undried infants (46.3%; risk ratio, 0.99; 95% CI, 0.79-1.24). The mean (SD) neonatal temperature at NICU admission was 36.4 °C (0.8 °C) in dried neonates and 36.5 °C (0.7 °C) in undried neonates (mean difference, -0.1 °C; 95% CI, -0.2 °C to 0.1 °C). In-hospital mortality included 26 of 177 dried neonates (14.7%) and 10 of 177 undried neonates (5.6%) (unadjusted risk ratio, 2.60; 95% CI, 1.29-5.23). The other secondary outcome measures were not different between the 2 arms. Conclusions and Relevance:In this multicenter randomized clinical trial, drying before plastic wrapping provided no benefit to very preterm infants in maintaining normothermia at NICU admission. Most deaths could be expected due to the compromised profile of the neonates, with no pathophysiological explanation related to the trial interventions. Approximately half of the infants were outside the normal thermal range at NICU admission; hence, thermal management remains a challenge requiring further investigations. Trial Registration:ClinicalTrials.gov Identifier: NCT05740072.

Importance Despite continuous improvements in neonatal resuscitation and stabilization in the last decades, thermal management immediately after birth remains an unresolved issue in preterm infants. Objective To compare 2 strategies of thermal management (plastic wrapping with or without drying) for preventing heat loss at birth in very preterm infants. Design, Setting, and Participants This multicenter, unblinded, randomized clinical trial was conducted among very preterm infants (birth weight <1500 g and/or gestational age ≤30 weeks 6 days) at 21 tertiary care hospitals in Italy from February 21, 2023, to July 18, 2024. Interventions Eligible neonates were randomly allocated to either drying before plastic wrapping in the delivery room (intervention arm) or plastic wrapping without drying (control arm). Main Outcomes and Measures The primary outcome was the proportion of participants with normothermia (36.5-37.5 °C) at admission to the neonatal intensive care unit (NICU). The secondary outcomes included hypothermia (<36.5 °C), moderate to severe hypothermia (<36.0 °C), and hyperthermia (>37.5 °C) at NICU admission, temperature at 1 hour after NICU admission, intraventricular hemorrhage, respiratory distress syndrome, late-onset sepsis, bronchopulmonary dysplasia, and mortality before hospital discharge. Results Overall, 354 very preterm infants were randomized (180 [50.8%] female; mean [SD] gestational age, 28.6 [2.5] weeks); all received the allocated intervention and were included in the analysis. Normothermia at NICU admission was achieved in 81 of 177 dried infants (45.8%) and 82 of 177 undried infants (46.3%; risk ratio, 0.99; 95% CI, 0.79-1.24). The mean (SD) neonatal temperature at NICU admission was 36.4 °C (0.8 °C) in dried neonates and 36.5 °C (0.7 °C) in undried neonates (mean difference, −0.1 °C; 95% CI, −0.2 °C to 0.1 °C). In-hospital mortality included 26 of 177 dried neonates (14.7%) and 10 of 177 undried neonates (5.6%) (unadjusted risk ratio, 2.60; 95% CI, 1.29-5.23). The other secondary outcome measures were not different between the 2 arms. Conclusions and Relevance In this multicenter randomized clinical trial, drying before plastic wrapping provided no benefit to very preterm infants in maintaining normothermia at NICU admission. Most deaths could be expected due to the compromised profile of the neonates, with no pathophysiological explanation related to the trial interventions. Approximately half of the infants were outside the normal thermal range at NICU admission; hence, thermal management remains a challenge requiring further investigations. Trial Registration ClinicalTrials.gov Identifier: NCT05740072

AIM:Neonatal resuscitation follows national or regional guidelines, but uptake varies in clinical practice. This study aimed to examine variations in reported delivery room practices for infants < 29 weeks' gestation across neonatal units in 12 networks of the International Network for Evaluating Outcomes in Neonates. METHODS:An online pre-piloted survey was sent to 608 neonatal units across 12 networks. Responses, based on 2022-2023 practices, were categorized as very frequent (90%-100%), often (50%-89%), sometimes (10%-49%), rarely (1%-9%), and never, and summarized as frequency of units per network. RESULTS:Overall, 382 units (63%) responded (37%-100% within network). Active resuscitation at 22, 23 and 24 weeks was reported as 'very frequent/often' by 22%, 53% and 76% of units, with variation. Delayed cord clamping, cord milking, and resuscitation with intact cord were 'very frequent/often' in 47%, 27% and 7% of units. Japan reported 75% cord milking. For initial respiratory support, 86% reported oxygen concentration < 40%. Intubation at birth for infants 27-28 weeks was uncommon except in Japan. Surfactant delivery room use was reported by 24% of units. CONCLUSIONS:Delivery room management of very preterm infants varies across networks. Future studies should analyse the impact of reported delivery room practices on neonatal outcomes.

100% oxygen with the cord intact improves early oxygenation in preterm infants.

Reference values for tissue Doppler imaging (TDI) parameters in neonates remain limited and are not consistently defined across gestational ages or postnatal periods. We conducted a systematic review and meta-analysis to define normal ranges for TDI-derived myocardial performance indices in healthy term and preterm newborns, stratified by gestational age (GA) and day of life (DOL). We searched MEDLINE, EMBASE, and CENTRAL up to April 2024 for observational studies reporting TDI measures in neonates grouped by GA (< 32, 32–36, ≥ 37 weeks) and DOL (≤ 7, > 7). Study quality was assessed using the checklist, and evidence certainty was evaluated with a modified GRADE approach. Thirty-five studies including 3747 neonates were included in the analysis, comprising 1635 term and 2112 preterm infants. We analyzed peak systolic (s′), early (e′) and atrial (a′) diastolic velocities, as well as isovolumic contraction and relaxation times, ejection time, and ventricular filling time. TDI parameters increased with GA and DOL, reflecting early postnatal hemodynamic changes. Conclusion: This meta-analysis provides robust, clinically relevant reference ranges for TDI parameters in neonates across gestational and postnatal ages, supporting their broader use in functional cardiac assessment and informing future research directions.

Abstract Background The issue of retreatment with surfactant of infants with respiratory distress syndrome (RDS) has been poorly investigated. Our aim was to identify possible clinical predictors of the need for multiple doses of surfactant in a large cohort of very preterm infants. Methods Data were analyzed from three previous studies on infants born between 25+ 0 and 31+ 6 weeks of gestation with RDS who were treated with surfactant. Results We studied 448 infants. Among them 306 (68%) were treated with a single dose of surfactant and 142 (32%) were treated with multiple doses. Multivariable mixed effects logistic regression analysis showed that the odd of requiring multiple doses of surfactant was significantly lower in patients with higher gestational age (27–28 vs. 25–26 wks: OR 0.46, 95% C.l. 0.26–0.79; ≥29 vs. 25–26 wks: OR 0.34, 95% C.l. 0.13–0.85; overall P = 0.013), while it increased in infants born to mothers with hypertensive disorders of pregnancy (OR 2.53, 95% C.l. 1.49–4.31; P < 0.001) and with hemodynamically significant PDA (OR 2.74, 95% C.l. 1.66–4.53, P < 0.001). Conclusions Gestational age, hypertension in pregnancy, and hemodynamically significant PDA can predict the need for multiple doses of surfactant. Further investigation is needed to evaluate if these sub-groups of preterm infants represent specific phenotypes of RDS who deserve a peculiar surfactant treatment.

There is no consensus regarding the timing and diagnostic criteria for identifying hemodynamically significant patent ductus arteriosus (hsPDA). Our aim was to evaluate if the use of different diagnostic criteria at different times could be associated with a different incidence of hsPDA in very preterm infants. We studied 41 infants with gestational age < 32 weeks born in neonatal intensive care units (NICU) in Florence, Italy, or in Paris, France. They received the first echocardiography between 24 and 48 h of life and the second between 72 and 84 h to diagnose hsPDA using Florence and Paris criteria and PDA severity score. Concordance of diagnosis between criteria was evaluated with the Cohen unweighted κ statistic. The incidence of hsPDA diagnosed by the Florence (35

Background: Fetal hemoglobin (HbF) plays a beneficial role in the progressive adaptation to the postnatal oxygen-rich environment in preterm infants due to its peculiar properties. Our aim was to evaluate if preterm infants resuscitated with delayed cord clamping (DCC) or umbilical cord milking (UCM) might have higher and more durable HbF levels than infants resuscitated with immediate cord clamping (ICC). Methods: We retrospectively studied 181 preterm infants born at <30 weeks of gestation, among whom 120 were resuscitated with ICC, 30 with DCC, and 31 with UCM. Mean values of HbF blood levels in the first postnatal week (HbF1st week); in the 14th, 21st, and 28th days of life (HbF14–21–28 DOL); and in the 31st, 34th, and 36th weeks of postmenstrual age (HbF31–34–36 weeks) were calculated. Results: We found that HbF1st week (15.3 ± 3.4 vs. 12.6 ± 3.5 g/dL, p < 0.001), HbF14–21–28 DOL, (9.3 ± 3.2 vs. 7.6 ± 3.6 g/dL, p = 0.018), and Hb–34–36 weeks (7.5 ± 3.6 vs. 5.7 ± 3.6 g/dL, p = 0.014) levels were higher in the UCM than in the ICC group. No differences of HbF levels were found between the DCC and ICC groups. Conclusions: UCM was associated with a persistent higher level of HbF than ICC. The effect of DCC was less marked as HbF level was higher than ICC only in the first week of life. UCM and DCC may help counteract the negative effects of blood sampling and transfusions on HbF levels.

The American Academy of Pediatrics (AAP) revised in 2022 its guideline on the management of neonatal hyperbilirubinemia and suggested a significant increase in the thresholds for phototherapy. Our aim was to evaluate if the implementation of these guideline could reduce admissions for hyperbilirubinemia requiring phototherapy in our unit. We studied 876 infants with gestational age ≥ 35 weeks who were admitted for hyperbilirubinemia requiring phototherapy during the first week of life. Total serum bilirubin (TSB) at the start of phototherapy, which was decided based on the guidelines of the Italian Society of Neonatology, was compared with the TSB thresholds recommended by AAP 2022 guidelines. Seven hundred and thirteen (82

Background:Respiratory distress syndrome (RDS) is commonly treated in preterm infants with surfactant and artificial respiratory support. However, their effects have been demonstrated in infants born before 30 weeks of gestational age, while there are no data on the efficacy of surfactant treatment and retreatment in the subgroup of moderately preterm infants (MPIs). We aimed to assess changes in oxygenation indices and RDS severity after surfactant administration in MPIs and to identify possible risk factors for the need for multiple doses of surfactant in these patients. Methods:We conducted a retrospective study on 60 MPIs born between 30+0 and 33+6 weeks of gestational age who were affected by RDS and required surfactant treatment. Peripheral oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio and arterial/alveolar partial pressure of oxygen (a/APO2) ratio before and after the administration of the first and second surfactant doses were calculated. Clinical characteristics of infants who required one or more doses of surfactant were compared. Results:A total of 48 infants (80%) received a single dose of surfactant, while 12 infants (20%) received multiple doses. Both the SpO2/FiO2 ratio and the a/APO2 ratio significantly increased after the first and second doses of surfactant. However, we did not identify any clinical predictors for the need of surfactant retreatment in this population. Receiver operating characteristic (ROC) analysis indicated that the SpO2/FiO2 ratio measured 1 h after administration of the first dose is a significant predictor of the need for additional doses. Conclusions:The first and second doses of surfactant improved the oxygenation indices and reduced the severity of RDS in MPIs. The post-surfactant SpO2/FiO2 ratio can be a useful adjunct in determining the need for additional doses of surfactant. These findings help further our understanding of the effects of surfactant treatment in MPIs.

Cyclic phototherapy (cPT) can achieve a reduction in total serum bilirubin comparable to that achieved with standard continuous PT in preterm infants. Our aim was to assess the effect of cPT on splanchnic (rSO2S) and cerebral (rSO2C) oxygenation measured by near-infrared spectroscopy (NIRS). We prospectively studied 16 infants with a gestational age of 25–34 weeks with hyperbilirubinemia requiring PT. Splanchnic regional oxygenation (rSO2S), oxygen extraction fraction (FOES), and cerebro-splanchnic oxygenation ratio (CSOR) were recorded before, during, and after cPT discontinuation. We found that rSO2S, FOES, and CSOR did not change during the study period. The overall duration of single or multiple courses of PT was 6.5 (6.0–13.5) h, but by cycling PT, the actual exposure was 3.0 (1.5–4.9) h. Twelve patients (75

AIM:We developed the Promotion of Breastfeeding (PROBREAST) programme and evaluated what effect it had on the breastfeeding rate in infants born at less than 32 weeks of gestation or weighing ≤1500 grams. METHODS:We compared the breastfeeding rate in two cohorts of patients who were born before (n = 72; January 2017 to June 2018) and after (n = 80; July 2018 to December 2019) the application of the programme. Moreover, we compared the correlation between type of feeding at discharge and post-discharge breastfeeding rate, between exclusive breastfeeding, postnatal growth and neurodevelopment. RESULTS:Infants in the PROBREAST group had an exclusive breastfeeding rate at discharge higher (42 vs. 16%, p < 0.001) than that in the historical control group. Exclusive breastfeeding was negatively correlated with weight z-score at discharge, but not at 12 and 24 months corrected age, and was positively correlated with cognitive score at 24 months corrected age. CONCLUSION:The application of a structured programme for the promotion of breastfeeding improved the breastfeeding rate in very preterm infants. We demonstrated that exclusive breastfeeding at discharge improved their neurodevelopment without impairing growth.

Lung function has never been assessed during kangaroo mother care (KMC) in preterm infants. We measured lung (rSO2L) and cerebral (rSO2C) oxygenation by near-infrared spectroscopy (NIRS) in infants born at less than 32 weeks of gestation or weighing ≤ 1500 g during KMC. rSO2L, rSO2C, and pulmonary (FOEL) and cerebral (FOEC) tissue oxygen extraction fraction were measured in 20 preterm infants before, during, and after a 2-h period of KMC at a mean postnatal age of 36 ± 21 days of life. We found that rSO2L, rSO2C, FOEL, and FOEC did not change in our patients. After 120 min of KMC, rSO2L was lower (71.3 ± 1.4 vs. 76.7 ± 4.6

ImportanceAmong preterm newborns undergoing resuscitation, delayed cord clamping for 60 seconds is associated with reduced mortality compared with early clamping. However, the effects of longer durations of cord clamping with respiratory support are unknown.ObjectiveTo determine whether resuscitating preterm newborns while keeping the placental circulation intact and clamping the cord after a long delay would improve outcomes compared with umbilical cord milking.Design, Setting, and ParticipantsThis randomized clinical trial (PCI Trial) was conducted at 8 Italian neonatal intensive care units from April 2016 through February 2023 and enrolled preterm newborns born between 23 weeks 0 days and 29 weeks 6 days of gestation from singleton pregnancies.InterventionsEnrolled newborns were randomly allocated to receive at-birth resuscitation with intact placental circulation for 180 seconds or umbilical cord milking followed by an early cord clamping (within 20 seconds of life).Main Outcomes and MeasuresThe primary outcome was the composite end point of death, grade 3 to 4 intraventricular hemorrhage, and bronchopulmonary dysplasia at 36 weeks of postconception age. Prespecified secondary end points were the single components of the composite primary outcome. An intention-to-treat analysis was conducted.ResultsOf 212 mother-newborn dyads who were randomized, 209 (median [IQR] gestational age, 27 [26-28] weeks; median [IQR] birth weight, 900 [700-1070] g) were enrolled in the intention-to-treat population; 105 were randomized to the placental circulation intact group, and 104 were randomized to the cord milking group. The composite outcome of death, grade 3 to 4 intraventricular hemorrhage, or bronchopulmonary dysplasia occurred in 35 of 105 newborns (33%) in the placental circulation intact group vs 39 of 104 newborns (38%) in the cord milking group (odds ratio, 0.83; 95% CI, 0.47-1.47; P = .53).Conclusions and RelevanceIn a randomized clinical trial of preterm newborns at 23 to 29 weeks’ gestational age, intact placental resuscitation for 3 minutes did not lower the composite outcome of death, grade 3 to 4 intraventricular hemorrhage, or bronchopulmonary dysplasia compared with umbilical cord milking.Trial RegistrationClinicaltrials.gov Identifier: NCT02671305

Background: the importance of sucking milk directly at the mother's breast is often underestimated and many aspects of direct breastfeeding of very preterm infants are not investigated. Aim: The primary endpoint of the study was to identify maternal and infant clinical predictors of direct breastfeeding in a cohort of infants born at <32 weeks of gestation or weighing <1500 g. The secondary endpoint was to evaluate the possible effects of direct breastfeeding on infant neurodevelopment. Study design: Seventy-two infants born between July 2018 and December 2019 were divided into the subgroup that were directly breastfed (n = 42) and not directly breastfed (n = 30) at discharge. Maternal and infant characteristics were compared, and differences were analysed. Results: Logistic regression analysis demonstrated that the percentage of maternal milk taken during hospitalization, maternal age, and weight (z-score) at discharge were positively correlated with the likelihood of direct breastfeeding at discharge. Direct breastfeeding was not correlated with the cognitive score at 24 months corrected age. Conclusions: Direct breastfeeding at discharge is more probable in infants of older mothers who receive more breastmilk and who experience greater weight gain. Direct breastfeeding is not correlated with the cognitive score at 24 months corrected age.

Background: The effectiveness of repeated drug course to close or constrict a hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants has not been studied extensively. Our aim was to assess the effectiveness of a second or third course of treatment with ibuprofen and/or paracetamol in 107 infants with gestational age < 29 weeks. Methods: Infants with echocardiographic diagnosis of hsPDA were treated with ibuprofen, paracetamol, or with ibuprofen plus paracetamol between 24 and 72 h of life. Echocardiography was repeated at the end of each pharmacological course. Results: The failure rate of the first, second and third course of drug treatment was 38% (41/107), 76% (31/41), and 92% (24/26), respectively. Among 24 infants who failed treatment, 8 (31%) had closure or constriction of the hsPDA after >3 drug courses, 15 (57%) received surgical closure, and 3 (12%) died with hsPDA. Logistic regression analyses did not show independent risk factors for the failure of the second and third course of treatment. Conclusions: We found a higher failure rate of the second and third courses of drug treatment than previously reported. Planning the third and additional pharmacological courses at centers where the failure rate is very high may prolong the exposure of very preterm infants to the adverse effects of hsPDA.

BACKGROUND:Training programs on resuscitation have been developed using simulation-based learning to build skills, strengthen cognitive strategies, and improve team performance. This is especially important for residency programs where reduced working hours and high numbers of residents can reduce the educational opportunities during the residency, with lower exposure to practical procedures and prolonged length of training. Within this context, gamification has gained popularity in teaching and learning activities. This report describes the implementation of a competition format in the context of newborn resuscitation and participants' perceptions of the educational experience.METHODS:Thirty-one teams of three Italian pediatric residents participated in a 3-day simulation competition on neonatal resuscitation. The event included an introductory lecture, familiarization time, and competition time in a tournament-like structure using high-fidelity simulation stations. Each match was evaluated by experts in neonatal resuscitation and followed by a debriefing. The scenarios and debriefings of simulation station #1 were live broadcasted in the central auditorium where teams not currently competing could observe. At the end of the event, participants received an online survey regarding their perceptions of the educational experience.RESULTS:81/93 (87%) participants completed the survey. Training before the event mostly included reviewing protocols and textbooks. Low-fidelity manikins were the most available simulation tools at the residency programs. Overall, the participants were satisfied with the event and appreciated the live broadcast of scenarios and debriefings in the auditorium. Most participants felt that the event improved their knowledge and self-confidence and stimulated them to be more involved in high-fidelity simulations. Suggested areas of improvement included more time for familiarization and improved communication between judges and participants during the debriefing.CONCLUSIONS:Participants appreciated the simulation competition. They self-perceived the educational impact of the event and felt that it improved their knowledge and self-confidence. Our findings suggest areas of improvements for further editions and may serve as an educational model for other institutions.