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Visual attention on a respiratory function monitor during simulated neonatal resuscitation: an eye-tracking study
  1. Trixie A Katz1,
  2. Danielle D Weinberg2,
  3. Claire E Fishman3,
  4. Vinay Nadkarni4,
  5. Patrice Tremoulet5,6,
  6. Arjan B te Pas7,
  7. Aleksandra Sarcevic8,
  8. Elizabeth E Foglia2,3
  1. 1 Department of Neonatology, University of Amsterdam, Amsterdam, The Netherlands
  2. 2 Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  3. 3 Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
  4. 4 Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  5. 5 Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  6. 6 Department of Psychology, Rowan University, Glassboro, New Jersey, USA
  7. 7 Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands
  8. 8 Information Science Department, College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Elizabeth E Foglia, Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; foglia{at}


Objective A respiratory function monitor (RFM) may improve positive pressure ventilation (PPV) technique, but many providers do not use RFM data appropriately during delivery room resuscitation. We sought to use eye-tracking technology to identify RFM parameters that neonatal providers view most commonly during simulated PPV.

Design Mixed methods study. Neonatal providers performed RFM-guided PPV on a neonatal manikin while wearing eye-tracking glasses to quantify visual attention on displayed RFM parameters (ie, exhaled tidal volume, flow, leak). Participants subsequently provided qualitative feedback on the eye-tracking glasses.

Setting Level 3 academic neonatal intensive care unit.

Participants Twenty neonatal resuscitation providers.

Main outcome measures Visual attention: overall gaze sample percentage; total gaze duration, visit count and average visit duration for each displayed RFM parameter. Qualitative feedback: willingness to wear eye-tracking glasses during clinical resuscitation.

Results Twenty providers participated in this study. The mean gaze sample captured wa s 93% (SD 4%). Exhaled tidal volume waveform was the RFM parameter with the highest total gaze duration (median 23%, IQR 13–51%), highest visit count (median 5.17 per 10 s, IQR 2.82–6.16) and longest visit duration (median 0.48 s, IQR 0.38–0.81 s). All participants were willing to wear the glasses during clinical resuscitation.

Conclusion Wearable eye-tracking technology is feasible to identify gaze fixation on the RFM display and is well accepted by providers. Neonatal providers look at exhaled tidal volume more than any other RFM parameter. Future applications of eye-tracking technology include use during clinical resuscitation.

  • resuscitation
  • respiratory
  • technology
  • neonatology

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  • Contributors TK wrote the first draft of the manuscript. DDW, CEF, VN, PT, ABtP, AS and EEF critically revised the manuscript. CEF analysed and interpreted the data. TK, DDW, and EEF contributed to the study design, collected and analysed the data. VN, PT, ABtP, and AS contributed to the study design and analysed the data.No authors received any payments for drafting the manuscript and all authors approve the final version of the manuscript.

  • Funding This study was funded by National Institute of Child Health and Human Development (K23HD084727).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval University of Pennsylvania Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.