{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T08:40:39Z","timestamp":1787992839421,"version":"build-2784847793"},"reference-count":37,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T00:00:00Z","timestamp":1738022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Neonatal hypoxic-ischemic encephalopathy (HIE) due to perinatal complications remains an important pathology with a significant burden for neonates, families, and the healthcare system. Resuscitation and simulation team training are key elements in increasing patient safety. In this retrospective cohort study, we evaluated whether regular constant training of all personnel working in delivery rooms in South Tyrol improved the outcome of neonates with HIE. Methods: We retrospectively analyzed three groups of neonates with moderate to severe HIE who required therapeutic hypothermia. The first group included infants born before the systematic introduction of training and was compared to the second group, which included infants born after three years of regular training. A third group, which included infants born after the SARS-CoV-2 pandemic, was compared with the previous two to evaluate retention of skills and the long-term effect of our training program. Results: Over the three study periods, mortality decreased from 41.2% to 0% and 14.3%, respectively. There was also a significant reduction of patients with subclincal seizures detected only through EEG, from 47.1% in the first period to 43.7% and 14.3% in the second and third study periods, respectively. Clinical manifestations of seizures decreased significantly from 47.1% to 37.5% and 10.7%, respectively, as well as severe brain lesions in ultrasound (US) and MRI. Conclusions: In this study, constant and regular simulation training for all birth attendants significantly decreases mortality and improves the outcome in neonates with moderate to severe HIE. This positive effect seems to last even after a one-year period during which training sessions could not be performed due to the COVID-19 pandemic.<\/jats:p>","DOI":"10.3390\/jcm14030854","type":"journal-article","created":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T08:57:48Z","timestamp":1738054668000},"page":"854","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effects of Resuscitation and Simulation Team Training on the Outcome of Neonates with Hypoxic-Ischemic Encephalopathy in South Tyrol"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5769-1063","authenticated-orcid":false,"given":"Alex","family":"Staffler","sequence":"first","affiliation":[{"name":"Division of Neonatology\/NICU, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Bellutti","sequence":"additional","affiliation":[{"name":"Division of Neonatology\/NICU, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arian","family":"Zaboli","sequence":"additional","affiliation":[{"name":"Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Bacher","sequence":"additional","affiliation":[{"name":"Dornbirn City Hospital, Training Program for General Medicine, 6850 Dornbirn, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Chiodin","sequence":"additional","affiliation":[{"name":"Division of Neonatology\/NICU, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,28]]},"reference":[{"key":"ref_1","first-page":"9","article-title":"Ischemic conditioning and neonatal hypoxic ischemic encephalopathy: A literature review","volume":"1","author":"Adstamongkonkul","year":"2017","journal-title":"Cond. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s13760-020-01308-3","article-title":"Pathophysiology of hypoxic-ischemic encephalopathy: A review of the past and a view of the future","volume":"120","author":"Greco","year":"2020","journal-title":"Acta Neurol. Belg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1016\/S0140-6736(05)71048-5","article-title":"4 million neonatal deaths: When? Where? Why?","volume":"365","author":"Lawn","year":"2005","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e1273","DOI":"10.1016\/S2214-109X(21)00264-3","article-title":"Hypothermia for moderate or severe neonatal encephalopathy in low-income and middle-income countries (HELIX): A randomised controlled trial in India, Sri Lanka, and Bangladesh","volume":"9","author":"Thayyil","year":"2021","journal-title":"Lancet Glob. Health"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Krishnan, V., Kumar, V., Shankaran, S., and Thayyil, S. (2021). Rise and Fall of Therapeutic Hypothermia in Low-Resource Settings: Lessons from the HELIX Trial. Indian J. Pediatr.","DOI":"10.1007\/s12098-021-03861-y"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.brainres.2015.06.024","article-title":"Effect of matermal exercise on biochemical parameters in rats submitted to neonatal hypoxia-ischemia","volume":"1622","author":"Marcelino","year":"2015","journal-title":"Brain Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.clp.2024.04.012","article-title":"Uncovering the Role of Inflammation with Asphyxia in the Newborn","volume":"51","author":"Dhillon","year":"2024","journal-title":"Clin. Perinatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1093\/brain\/awp010","article-title":"Early brain temperature elevation and anaerobic metabolism in human acute ischaemic stroke","volume":"132","author":"Karaszewski","year":"2009","journal-title":"Brain"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.mpaic.2013.06.003","article-title":"Therapeutic hypothermia for brain injury","volume":"14","author":"Verco","year":"2013","journal-title":"Anaesth. Intensive Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1056\/NEJMoa0900854","article-title":"Moderate hypothermia to treat perinatal asphyxial encephalopathy","volume":"361","author":"Azzopardi","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1001\/jamapediatrics.2014.3269","article-title":"Hypoxic-ischemic encephalopathy: A review for the clinician","volume":"169","author":"Weiss","year":"2015","journal-title":"JAMA Pediatr."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Abate, B.B., Bimerew, M., Gebremichael, B., Mengesha Kassie, A., Kassaw, M., Gebremeskel, T., and Bayih, W.A. (2021). Effects of therapeutic hypothermia on death among asphyxiated neonates with hypoxic-ischemic encephalopathy: A systematic review and meta-analysis of randomized control trials. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0247229"},{"key":"ref_13","first-page":"F398","article-title":"Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Brain injury following trial of hypothermia for neonatal hypoxic-ischaemic encephalopathy","volume":"97","author":"Shankaran","year":"2012","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.1056\/NEJMcps050929","article-title":"Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy","volume":"353","author":"Shankaran","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/S0140-6736(05)17946-X","article-title":"Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: Multicentre randomised trial","volume":"365","author":"Gluckman","year":"2005","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Jacobs, S.E., Berg, M., Hunt, R., Tarnow-Mordi, W.O., Inder, T.E., and Davis, P.G. (2013). Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst. Rev., CD003311.","DOI":"10.1002\/14651858.CD003311.pub3"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.clp.2024.04.014","article-title":"Hypothermia for Hypoxic-ischemic Encephalopathy: Second-generation Trials to Address Gaps in Knowledge","volume":"51","author":"Laptook","year":"2024","journal-title":"Clin. Perinatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1542\/peds.2014-0899","article-title":"Hypothermia and neonatal encephalopathy","volume":"133","author":"Papile","year":"2014","journal-title":"Pediatrics"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.braindev.2016.09.005","article-title":"Neurodevelopmental outcome of term infants with perinatal asphyxia with hypoxic ischemic encephalopathy stage II","volume":"39","author":"Adhikari","year":"2017","journal-title":"Brain Dev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"04030","DOI":"10.7189\/jogh.12.04030","article-title":"Therapeutic hypothermia in neonatal hypoxic encephalopathy: A systematic review and meta-analysis","volume":"12","author":"Mathew","year":"2022","journal-title":"J. Glob. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1016\/j.ijgo.2009.07.016","article-title":"Two million intrapartum-related stillbirths and neonatal deaths: Where, why, and what can be done?","volume":"107","author":"Lawn","year":"2009","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/j.jpeds.2011.08.004","article-title":"Hypothermia and other treatment options for neonatal encephalopathy: An executive summary of the Eunice Kennedy Shriver NICHD workshop","volume":"159","author":"Higgins","year":"2011","journal-title":"J. Pediatr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1038\/pr.2013.206","article-title":"Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990","volume":"74","author":"Lee","year":"2013","journal-title":"Pediatr. Res."},{"key":"ref_24","first-page":"0320","article-title":"Perinatal asphyxia","volume":"2007","author":"McGuire","year":"2007","journal-title":"BMJ Clin. Evid."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s13052-021-00972-2","article-title":"High-Fidelity simulation-based program improves flow state scale in the perinatal team","volume":"47","author":"Strozzi","year":"2021","journal-title":"Ital. J. Pediatr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1111\/j.1471-0528.2006.00800.x","article-title":"Does training in obstetric emergencies improve neonatal outcome?","volume":"113","author":"Draycott","year":"2006","journal-title":"BJOG"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.braindev.2007.05.009","article-title":"The impact of Neonatal Resuscitation Program courses on mortality and morbidity of newborn infants with perinatal asphyxia","volume":"30","author":"Duran","year":"2008","journal-title":"Brain Dev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1136\/archdischild-2021-322216","article-title":"Impact of personal protective equipment on neonatal resuscitation procedures: A randomised, cross-over, simulation study","volume":"107","author":"Cavallin","year":"2022","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"S516","DOI":"10.1161\/CIRCULATIONAHA.110.971127","article-title":"Part 11: Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations","volume":"122","author":"Perlman","year":"2010","journal-title":"Circulation"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S543","DOI":"10.1161\/CIR.0000000000000267","article-title":"Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"132","author":"Wyckoff","year":"2015","journal-title":"Circulation"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"S185","DOI":"10.1161\/CIR.0000000000000895","article-title":"Neonatal Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations","volume":"142","author":"Wyckoff","year":"2020","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1001\/archneur.1976.00500100030012","article-title":"Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study","volume":"33","author":"Sarnat","year":"1976","journal-title":"Arch. Neurol."},{"key":"ref_33","first-page":"143","article-title":"Prediction of neuromotor outcome in perinatal asphyxia: Evaluation of MR scoring systems","volume":"19","author":"Barkovich","year":"1998","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1038\/s41390-022-02295-2","article-title":"Neuroprotective therapies in the NICU in term infants: Present and future","volume":"93","author":"Molloy","year":"2023","journal-title":"Pediatr. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"151904","DOI":"10.1053\/j.semperi.2024.151904","article-title":"Quality improvement and outcomes for neonates with hypoxic-ischemic encephalopathy: Obstetrics and neonatal perspectives","volume":"48","author":"Afifi","year":"2024","journal-title":"Semin. Perinatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"747.e1","DOI":"10.1016\/j.ajog.2015.12.037","article-title":"Contributory factors and potentially avoidable neonatal encephalopathy associated with perinatal asphyxia","volume":"214","author":"Sadler","year":"2016","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"47","DOI":"10.3233\/NPM-210737","article-title":"Effect of dexmedetomidine on heart rate in neonates with hypoxic ischemic encephalopathy undergoing therapeutic hypothermia","volume":"15","author":"Elliott","year":"2022","journal-title":"J. Neonatal Perinat. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/3\/854\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:37:31Z","timestamp":1759919851000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/3\/854"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,28]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14030854"],"URL":"https:\/\/doi.org\/10.3390\/jcm14030854","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,28]]}}}