Construction requirements for full-term newborn simulation manikin

Introduction
In the Netherlands, approximately 4500 newborns are admitted each year in the Neonatal Intensive Care Unit (NICU). In order to determine and practice optimal treatment for these fragile patients, clinicians increasingly use educative simulation. However, a high-fidelity simulation of the newborn with automated sensing and response is still missing.

Methods
It is our goal to do an assessment of necessary requirements for the construction of such high-fidelity simulation. For this, in-situ observations at one NICU and three neonatal simulation centers are conducted together with interviews with experts (obstetricians, neonatologists, paediatricians, nurses). In addition, a scientific-literature review and product-market research is performed.

Results
Current neonatal simulations rely on extensive manual manipulation of physiological variables, as the scenario develops, or on highly rigid scripts. For manikin-based simulations, histological and anatomical properties are usually disregarded, diminishing tactile experience. Such constraints can lead to suboptimal learning, decreasing deductive reasoning and increasing cognitive dissonance.

Closer to reality simulations seem achievable via a manikin that accounts for histological and anatomical properties. An integrated mathematical model of the physics, physiology and common pathologies of the newborn combined with embedded sensors and actuators could increase realism and flexibility of the scenario. Focus should be on the cardiovascular and respiratory systems, as main emergency situations involve ABC (airway, breathing, cardiovascular) intervention protocols.

Conclusion
With these requirements, we expect an increase of deductive reasoning and decrease of cognitive dissonance. In this way, quality of medical education can be improved further. This consequently aids in delivering better neonatal care and increasing patient survival.