Comparative Evaluation of 3 Neonatal Simulators for Neonatal Resuscitation and Airway Obstruction Skills in Medical Students

Abstract

Objectives:

To compare the effectiveness of 3 neonatal simulators in training medical students in resuscitation skills.

Introduction:

Simulation-based training is a critical component of neonatal resuscitation education. However, few studies have compared the educational value of different neonatal simulators.

Methods:

Sixty-eight fourth-year medical students participated in a Pediatric Advanced Life Support simulation session using the Brayden Baby, Prestan Professional, and Baby Anne simulators. Following hands-on practice, students completed a Likert-scale questionnaire evaluating each simulator. Data were analyzed using Chi-square tests.

Results:

Brayden Baby was significantly preferred in 7 out of 9 categories, including ease of positioning, ventilation, mask placement, and overall realism (P < .05). Baby Anne was rated highest for realism in foreign body removal.

Conclusion:

Brayden Baby emerged as the most effective simulator, indicating its greater suitability for neonatal training. Careful simulator selection may enhance learning outcomes in neonatal resuscitation education.

Introduction

Simulation-based training has become essential in modern medical education, particularly in high-risk and time-sensitive areas such as neonatal resuscitation and airway obstruction management. It offers learners a safe environment to develop clinical competence without putting real patients at risk. Studies have shown that simulation improves procedural skills, learner confidence, and decision-making in emergency settings.^1,2

Our institution has integrated simulation training into the pediatric curriculum for fourth-year medical students since the 2017 to 2018 academic year. This includes instruction in neonatal airway management and resuscitation techniques using a variety of manikin-based simulators.

This study aims to compare the effectiveness of 3 neonatal simulators—Brayden Baby, Prestan Professional, and Baby Anne—in supporting the development of key neonatal resuscitation and airway obstruction skills. By evaluating student perceptions following a structured simulation session, the study seeks to identify which simulator provides the most realistic and educationally valuable training experience. These findings are intended to inform future decisions regarding simulator selection and curriculum design in pediatric simulation training.

Methods

This study was conducted during the fall semester of the 2023 to 2024 academic year with fourth-year medical students at the University. As part of the pediatric course, students participated in a 3-hour simulation session focused on Pediatric Advanced Life Support (PALS 3), which incorporated the use of 3 different neonatal simulators: Brayden Baby, Prestan Professional, and Baby Anne. The session was designed to provide students with hands-on experience in performing neonatal resuscitation and airway obstruction techniques.

Following the simulation session, an anonymous, voluntary questionnaire was distributed to the students to assess their perceptions of the 3 simulators. The questionnaire, developed specifically for this study, consisted of 10 statements related to students’ experiences with the simulators. These statements, presented in Table 1, were rated on a five-point Likert scale, ranging from “Very Poor” to “Excellent.” The 68 participants were asked to rate the simulators in terms of usability, realism, and effectiveness in replicating clinical scenarios relevant to neonatal resuscitation and airway management. Written informed consent was obtained from all participants before they participated in the study.

Table 1.

Questionnaire Items for Evaluating Simulator Usability.

Items	Very poor	Poor	Average	Good	Excellent
1. It is comfortable to work with the simulator
2. It is comfortable to place the simulator in the right position
3. It is convenient to place the mask on the face of the simulator
4. The simulator is convenient for evaluating artificial ventilation techniques(rhythm, volume)
5. The simulator reacts to high-pressure ventilation
6. The simulator is comfortable for evaluating hand positions during compressions
7. The simulator is convenient for evaluating the depth and rhythm of chest compressions
8. The simulator allows assessment of correct coordination (compression–ventilation) when performing full CPR
9. The simulator is convenient for learning the foreign body extraction technique
10. Working with a mannequin is close to the real situation

The study design was structured around 7 small-group workshops, each of which included students performing all required neonatal procedures on each of the 3 simulators. After completing the hands-on exercises with each simulator, students provided feedback via the questionnaire.

The collected data were analyzed using content analysis to identify trends in students’ perceptions of the simulators. Statistical comparisons of the responses were conducted using the Chi-square test to examine any significant differences in the distribution of responses across the 3 simulators. This approach allowed for the identification of which simulator was most effective in providing a realistic and educationally valuable experience for students.

The results of this analysis were used to conclude the comparative effectiveness of the 3 neonatal simulators, with particular emphasis on their suitability for teaching neonatal resuscitation and airway obstruction skills.

Ethical Approval and Informed Consent

This non-interventional, observational study analyzed medical students’ feedback collected during routine clinical training. Ethical approval was not required, as confirmed by the Tbilisi State Medical University Biomedical Research Ethics Committee (IRB Reference: #2-2024/109). The survey was anonymous, and no personal or identifiable information was collected. Participation was voluntary, and informed consent was obtained through the voluntary completion of the anonymous questionnaire. Participants were informed about the study’s purpose, the voluntary nature of participation, and confidentiality measures before data collection.

Results

A total of 68 medical students (a 97% response rate) participated in the survey, evaluating 3 different resuscitation simulators (Brayden Baby, Prestan Professional, and Baby Anne) based on 10 Likert-scale questions. The responses indicated that Brayden Baby was consistently preferred across various categories, demonstrating its superiority in several aspects of resuscitation training. All reported data are presented in frequencies, percentages, and statistical comparisons.

Comfort of Working With the Simulator

Respondents were asked to rate the comfort level of working with each neonatal resuscitation simulator on a 5-point Likert scale, where 1 = Very poor, 2 = Poor, 3 = Average, 4 = Good, and 5 = Excellent. For Brayden Baby, 66 out of 68 respondents (97%) rated the simulator as either “Good” (34 responses) or “Excellent” (32 responses). In comparison, the Prestan Professional simulator received “Good” or “Excellent” ratings from 38 respondents (56%), and Baby Anne received such ratings from 32 respondents (47%). This distribution indicates a significantly higher comfort level reported for Brayden Baby (P < .001), suggesting it is more ergonomically designed, as illustrated in Figure 1.

Figure 1.

Comfort level of working with each neonatal resuscitation simulator.

Positioning the Simulator for Resuscitation Manipulation

When asked about the ease of positioning the simulator during resuscitation, 58 out of 67 respondents (85%) rated Brayden Baby as either “Good” or “Excellent.” In comparison, 43 respondents (63%) rated Prestan Professional similarly, and 50 respondents (74%) rated Baby Anne as either “Good” or “Excellent.” Brayden Baby was significantly preferred for positioning (P = .002), indicating greater ease of use as shown in Figure 2.

Figure 2.

Ease of positioning the simulator during resuscitation.

Mask Placement

For mask placement during positive pressure ventilation, 63 out of 68 respondents (93%) rated Brayden Baby as either “Good” or “Excellent.” In comparison, 50 respondents (74%) rated Prestan Professional similarly, and 54 respondents (79%) rated Baby Anne as either “Good” or “Excellent.” Brayden Baby was significantly preferred for mask placement (P < .001), demonstrating superior performance in this task, as shown in Figure 3.

Figure 3.

Preference for mask placement during positive pressure ventilation.

Evaluation of Artificial Ventilation Technique (Rhythm and Volume)

In evaluating artificial ventilation techniques, 63 out of 68 respondents (93%) rated Brayden Baby as either “Good” or “Excellent.” In comparison, 43 respondents (63%) rated Prestan Professional similarly, and 35 respondents (51%) rated Baby Anne as “Good” or “Excellent.” Brayden Baby showed a significant advantage (P < .001) in evaluating both rhythm and volume during ventilation, highlighting its superior performance, as illustrated in Figure 4.

Figure 4.

Evaluation of artificial ventilation techniques (rhythm and volume).

High Pressure Ventilation

For assessing high-pressure ventilation, 61 out of 68 respondents (90%) rated Brayden Baby as either “Good” or “Excellent.” In contrast, 29 respondents (43%) gave similar ratings to Prestan Professional, and 39 respondents (57%) did so for Baby Anne. Statistical analysis revealed a significant difference in favor of Brayden Baby (P < .001), highlighting its effectiveness in detecting and demonstrating high-pressure ventilation, as shown in Figure 5.

Figure 5.

Preference for high-pressure ventilation techniques.

Hand Positioning During Chest Compressions

For evaluating hand positioning, 87% of respondents rated Brayden Baby as “Good” or “Excellent,” with only 1 rating it as “Poor” and none as “Very Poor.” Prestan Professional received “Good” or “Excellent” ratings from 71%, while 19% rated it as “Average” or lower. Baby Anne had the lowest positive ratings (46%), with 35% rating it as “Average” and 22% as “Poor” or “Very Poor.” Brayden Baby showed a significant advantage for this task (P < .01), as illustrated in Figure 6.

Figure 6.

Hand positioning during chest compressions.

Chest Compression Depth and Rhythm Assessment

For assessing chest compression depth and rhythm, 63 out of 67 respondents (93%) rated Brayden Baby as “Good” or “Excellent,” with only 1 rating it as “Poor” and none as “Very Poor.” Prestan Professional received “Good” or “Excellent” ratings from 53 respondents (78%), while 15% rated it as “Average” or below. Baby Anne received the lowest positive ratings—only 29 respondents (43%) rated it as “Good” or “Excellent,” while 39% rated it as “Average” and 25% as “Poor” or “Very Poor.” Brayden Baby was rated significantly higher for this task (P < .001), as shown in Figure 7.

Figure 7.

Chest compression depth and rhythm assessment.

Coordination of Compression and Ventilation (CPR)

In evaluating the simulator’s ability to support assessment of correct compression–ventilation coordination during CPR, 62 out of 65 respondents (91%) rated Brayden Baby as “Good” or “Excellent,” with only 2 rating it as “Average” and 3 as “Poor” or lower. Prestan Professional received “Good” or “Excellent” ratings from 43 respondents (63%), but 24% rated it as “Average” and 12% as “Poor” or “Very Poor.” Baby Anne received the lowest positive ratings, with only 29 respondents (43%) selecting “Good” or “Excellent,” while 24 rated it as “Average” and 13 (20%) as “Poor” or “Very Poor.” These results indicate a statistically significant advantage for Brayden Baby (P < .001), suggesting it offers superior functionality for evaluating coordinated CPR performance, as demonstrated in Figure 8.

Figure 8.

Coordination of chest compressions and ventilation (CPR).

Foreign Body Removal Technique

Respondents rated the simulators on how comfortable they were for learning foreign body removal techniques. Baby Anne received the highest proportion of favorable ratings, with 55 out of 63 respondents (87%) rating it as “Good” (19) or “Excellent” (36). Brayden Baby was rated similarly, with 54 out of 68 respondents (79%) giving “Good” (35) or “Excellent” (19) scores. In contrast, Prestan Professional received “Good” or “Excellent” ratings from only 40 out of 67 respondents (60%), while 27 respondents rated it as “Average” or lower.

Statistical analysis showed no significant difference between Brayden Baby and Baby Anne (P = .512), but both were rated significantly higher than Prestan Professional, suggesting greater ease of use and realism for training in foreign body removal, as shown in Figure 9.

Figure 9.

Comfort for foreign body removal technique.

Realism of the Simulator (Proximity to Real-Life Situation)

Respondents assessed how closely each simulator replicated real-life clinical situations. Brayden Baby received the highest ratings, with 62 out of 67 respondents (92%) rating it as either “Good” (21) or “Very Good” (41). Baby Anne was also rated highly, with 59 respondents (87%) selecting “Good” (23) or “Very Good” (36). Prestan Professional received lower ratings overall, with only 41 respondents (61%) rating it as “Good” (30) or “Very Good” (11), and 26 respondents (39%) scoring it as “Average” or lower.

Although Brayden Baby was rated slightly higher, statistical analysis revealed a small but significant difference (P = .045), indicating that both Brayden Baby and Baby Anne were considered similarly realistic by most respondents, as illustrated in Figure 10.

Figure 10.

Realism of simulators in replicating real-life situations.

Feedback Analysis

Using Chi-square tests, differences in students’ perceptions across the 3 simulators were examined. Brayden Baby was consistently preferred over Prestan Professional and Baby Anne across nearly all evaluated domains, including comfort during use, ease of patient positioning, mask placement and airway management, positive pressure and high-pressure ventilation techniques, chest compression depth and rhythm, and overall realism. These domains showed statistically significant results (P < .05). For example, Brayden Baby was rated as more realistic than both Baby Anne and Prestan Professional (χ² = 23.4, df = 2, P < .001), and it was also the top choice for mask placement and ventilation assessments (χ² = 19.7, df = 2, P < .001). The only area where Brayden Baby and Baby Anne showed similar results was in foreign body removal techniques, where no significant preference was observed between the 2 simulators (χ² = 2.4, df = 2, P = .30), indicating that both were perceived as equally effective for this specific task. Prestan Professional was consistently the least favored simulator across all categories assessed.

Discussion

This study evaluated the comparative effectiveness of 3 neonatal simulators in teaching critical neonatal resuscitation and airway obstruction skills. The findings indicate that Brayden Baby was significantly preferred by students across nearly all key performance domains, highlighting its educational value and superior realism.

These results are consistent with previous literature that emphasizes the importance of high-fidelity simulation in healthcare education. High-fidelity simulators offer realistic anatomical and physiological feedback that closely mimics actual clinical scenarios, thereby enhancing skill acquisition, procedural competence, and learner confidence.^1,3 In contrast, low-fidelity simulators may limit experiential learning by lacking critical features such as resistance feedback, airway patency variation, and dynamic physiological responses. ²

The Brayden Baby’s high rating in tasks like mask placement, artificial ventilation, and chest compressions reinforces prior findings that sensor-enhanced manikins can effectively improve technical skill proficiency.^3,4 For instance, Takebe et al developed a neonatal airway management simulator with embedded sensors that allowed for precise measurement of intubation technique, offering more detailed and objective feedback than traditional models. ³ Similarly, Haynes et al showed that realistic ventilation patterns in high-fidelity simulators improved learners’ skill retention and performance. ⁴

Interestingly, while Brayden Baby was superior in most areas, Baby Anne showed comparable effectiveness in foreign body removal. This suggests that low- to mid-fidelity simulators may still hold value for specific procedural tasks, especially in resource-limited educational settings where high-fidelity models may not be feasible.

Prestan Professional, on the other hand, was rated lowest in most domains. Its limited realism and lack of dynamic feedback mechanisms likely contributed to its lower evaluation, which aligns with findings by Maurya et al that low-fidelity simulators may not effectively support the development of fine motor or advanced airway skills. ²

It’s important to consider, however, that high-fidelity simulation alone may not guarantee transferability to clinical practice. As Finan et al note, improved performance in simulated environments does not always translate to real-world effectiveness. ⁵ Therefore, simulation should be integrated with hands-on clinical experience and longitudinal skill development.

Moreover, simulation does more than teach technical skills. Structured scenarios have been shown to enhance non-technical competencies such as communication, leadership, and teamwork, which are essential during high-pressure neonatal resuscitation events.^6,7 This broader scope of learning supports the integration of simulation-based education into interprofessional and multidisciplinary training programs.

This study offers insights for institutions and organizations evaluating neonatal resuscitation simulators.

Limitations

This study has several limitations. The participants were Year 4 medical students, who may not have had sufficient clinical experience to accurately assess the realism of neonatal resuscitation. Additionally, the sample size of 68 students may limit the generalizability of the findings. The study relied on self-reported data, which could have been influenced by personal biases, and it did not incorporate objective performance measures or assess long-term skill retention. Key aspects, such as airway view and accessibility, were not evaluated in this study. This is an area that could provide valuable insights for future research. Finally, the 3-hour session may not have allowed sufficient time for participants to fully engage with or assess all aspects of the simulators.

Conclusion

Brayden Baby emerged as the most effective simulator for teaching neonatal resuscitation and airway obstruction skills among Year 4 medical students, outperforming Baby Anne and Prestan Professional in realism, technical skill development, and user preference. These results support the integration of high-fidelity simulators into pediatric training programs to optimize educational outcomes. Future research should investigate long-term skill retention and the role of team-based simulation in enhancing interprofessional collaboration during neonatal emergencies.