IntroductionEmergency neonatal resuscitation equipment is often organized into “code carts”. Simulation studies previously examined human factors of neonatal code carts and equipment; however, visual attention analysis with eye-tracking might further inform equipment design.ObjectivesTo evaluate human factors of neonatal resuscitation equipment by: (1) comparing epinephrine preparation speed from adult pre-filled syringe vs. medication vial, (2) comparing equipment retrieval times from two carts and (3) utilizing eye-tracking to study visual attention and user experience.MethodsWe conducted a 2-site randomized cross-over simulation study. Site 1 is a perinatal NICU with carts focused on airway management. Site 2 is a surgical NICU with carts improved with compartments and task-based kits. Participants were fitted with eye-tracking glasses then randomized to prepare two epinephrine doses using two methods, starting with an adult epinephrine prefilled syringe or a multiple access vial. Participants then obtained items for 7 tasks from their local cart. Post-simulation, participants completed surveys and semi-structured interviews while viewing eye-tracked video of their performance. Epinephrine preparation times were compared between the two methods. Equipment retrieval times and survey responses were compared between sites. Eye-tracking was analyzed for areas of interest (AOIs) and gaze shifts between AOIs. Interviews were subject to thematic analysis.ResultsForty HCPs participated (20/site). It was faster to draw the first epinephrine dose using the medication vial (29.9s vs. 47.6s, p < 0.001). Time to draw the second dose was similar (21.2s vs. 19s, p = 0.563). It was faster to obtain equipment from the Perinatal cart (164.4s v 228.9s, p < 0.027). Participants at both sites found their carts easy to use. Participants looked at many AOIs (54 for Perinatal vs. 76 for Surgical carts, p < 0.001) with 1 gaze shifts/second for both.Themes for epinephrine preparation include: Facilitators and Threats to Performance, and Discrepancies due to Stimulation Conditions. Themes for code carts include: Facilitators and Threats to Performance, Orienting with Prescan, and Suggestions for Improvement. Suggested cart improvements include: adding prompts, task-based grouping, and positioning small equipment more visibly. Task-based kits were welcomed, but more orientation is needed.ConclusionsEye-tracked simulations provided human factors assessment of emergency neonatal code carts and epinephrine preparation.

<b><i>Background:</i></b> Stepwise lung recruitment maneuvers (LRMs) may be used in ventilated preterm infants. However, its use in high-frequency oscillation with volume guarantee (HFO-VG) is not well studied. <b><i>Methods:</i></b> Preterm infants treated with HFO-VG who had LRMs were identified. Patient and respiratory parameters were recorded. <b><i>Results:</i></b> Ten infants, median GA 25⁺⁶ (IQR 24⁺²–27⁺⁰) weeks, and 21 LRMs were identified. LRMs were performed at a median age of 26 days, with a starting MAP of 16 (14–17) cm H₂O and the highest MAP of 23.5 (22.0–24.8) cm H₂O. Most (76%) resulted in immediate improved SpO₂/FiO_2. There were no sustained differences in median oxygen saturation index (8.4 vs. 9, <i>p</i> = 0.09), SpO₂/FiO₂ (1.8 vs. 1.8, <i>p</i> = 0.8), ∆P (21 vs. 23, <i>p</i> = 0.64), or transcutaneous CO₂ (58 vs. 60, <i>p</i> = 0.84) in 24 h before and after LRMs. <b><i>Conclusions:</i></b> In preterm infants with evolving bronchopulmonary dysplasia, LRMs on HFO-VG did not result in sustained improvement to oxygenation or ventilation.