The Mask’D Effect - Do Masks Impede Our Communication During Neonatal Resuscitation?

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Submission ID :
ESPR135
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Abstract: :

Background: The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) currently recommend the universal wearing of facemasks in hospitals and the community during the COVID-19 crisis. In these critical times, masked communication is the new norm - at least in the immediate future. Neonatal resuscitation in the delivery room is a stressful situation with beeping alarms and distracting conversations. This could be further exacerbated by using masks that may attenuate and distort the voice/sound and conceal lip-reading cues. Neonatal resuscitation providers wearing N95 facemask and personal protective equipment are usually a foot apart in the delivery room and are required to resuscitate a neonate who is suspected of having COVID-19.

Objective: Study the effect of no mask and different kinds of masks (surgical and N95) on sound levels, in a simulated neonatal resuscitation environment when providers are a foot apart.

Methods:  Thirty-five healthcare providers (table1) trained in neonatal resuscitation who attend high-risk deliveries in a regional perinatal center were asked to communicate 6 separate commands (Figure 1) while standing at the head end of the resuscitation table: a) without a mask, b) with a surgical mask and, c) with an N95 mask. We simulated two scenarios to mimic an emergent situation in our single room neonatal intensive care unit (NICU): Scenario I) a room with no ambient noise, Scenario II) a room with a simulated delivery room ambient noise. Using the iPhone application, Decibel X, the sound was recorded in decibels (dB) one foot away from the provider (the typical distance that the second provider would be located). The ambient noise in a delivery room requiring emergent delivery and extensive neonatal resuscitation was 60±5 dB.

Results: The sound levels measured while wearing no mask, surgical mask, and N95 in two different scenarios are shown in Figure 1. In both scenarios, the sound level without any mask was significantly higher compared to surgical & N95 masks. With N95 masks, the sound recorded were non-significantly lower compared to surgical masks in both scenarios. With ambient noise, the providers had to communicate +10 dB louder (p<0.0001) as shown in Figure 1.

Conclusion: In a simulated environment, with or without ambient noise, sound levels of typical neonatal resuscitation commands were diminished with the use of a mask. The use of N95 did not significantly reduce the sound measured compared to wearing a surgical mask during communication. The effect on comprehension needs to be evaluated further to understand the clinical impact of mask guidelines during emergent situations when accurate communication is critical.

University at Buffalo
University at Buffalo
University at Buffalo
University at Buffalo
University at Buffalo

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