Objective:

To explore the barriers to the adoption of respiratory function monitors (RFMs) in neonatal resuscitation despite their potential benefits.

Approach:

• Evidence Review: A systematic review and meta-analysis of randomized controlled trials assessing RFMs in neonatal resuscitation.
• Clinician Experience Studies: Exploration of clinician experiences and training related to RFMs, including educational interventions.
• Device Usability Assessment: Analysis of clinician interactions with RFMs during simulated neonatal resuscitation and the importance of interface design.
• Market Analysis: Examination of the commercial viability and development challenges of RFMs in the neonatal market.

Key Findings:

• Pooled analysis from three trials showed reduced brain injury (RR 0.65, 95% CI 0.48 to 0.88, p=0.006) and intraventricular hemorrhage (RR 0.68, 95% CI 0.49 to 0.95, p=0.02) with RFMs.
• Major resuscitation bodies have not recommended routine use of RFMs due to insufficient evidence.
• Clinicians reported a high level of comfort with RFMs after brief training, but usability issues remain.
• Interface complexity and the need for intuitive design are critical for effective RFM use in time-sensitive situations.
• Development of RFMs faces challenges in translating clinician needs into commercially viable products.

Interpretation:

Despite promising evidence of clinical benefits, RFMs face significant barriers to implementation, including usability, training, and market challenges.

Limitations:

• Limited high-quality evidence and small sample sizes in existing trials.
• Substantial heterogeneity in trial designs and outcome definitions.
• Insufficient training and uncertainty in data interpretation among clinicians.

Conclusion:

Addressing usability, training, and development challenges is essential for the successful implementation of RFMs in neonatal resuscitation.