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How stressful is the Newborn Life Support airway test? An observational study
  1. Nicola Holme1,
  2. Catherine Harrison1,
  3. Paul Newland2,
  4. Ben N J Shaw3
  1. 1Leeds Neonatal Service, Leeds Teaching Hospitals Trust, Leeds, UK
  2. 2Biochemistry Department, Alder Hey Children's Hospital, Liverpool, UK
  3. 3NICU, Liverpool Women's Hospital, Liverpool, UK
  1. Correspondence to Dr Nicola Holme, Peter Congdon Neonatal Unit, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK; nicolaholme{at}


Objectives To determine whether there is a significant stress response to the Newborn Life Support airway test (NLSAT) among healthcare professionals in the UK.

Design Quantitative study measuring both stress and anxiety of candidates on Newborn Life Support (NLS) courses measuring salivary cortisol levels along with validated anxiety questionnaires (State Trait Anxiety Inventory).

Setting UK NLS course centres.

Participants 80 healthcare professionals (nurses, doctors and midwives) on NLS courses.

Interventions Stress levels measured (cortisol swabs and State-Trait Anxiety Inventory (STAI)) at baseline, immediately before and 20 min after starting the NLSAT.

Results Cortisol measurements failed to detect any significant rise in stress levels as a result of the NLSAT. Significant anxiety was induced by the NLSAT based on STAI scores. STAI scores rose significantly in all professionals from baseline to post-NLSAT, with the greatest change detected for midwives (+11.82 (SD 7.64, p<0.001)) compared with nurses (+8.86 (SD 12.1, p<0.001)) and doctors (+7.96 (SD 2.9.69, p<0.001)). Experience had no impact on stress levels.

Conclusions Anxiety levels induced by the NLSAT are significant and should be considered when instructing and developing the NLS course.

  • Resuscitation
  • Newborn
  • Assessment
  • Stress
  • Multi-professional

Statistics from


  • Contributors NH wrote the study protocol, conducted the research and wrote the article. CH and BNJS supervised the design and implementation of the study, and reviewed the content of the article. PN provided input to the study design and enabled salivary cortisol samples to be analysed. BNJS provided assistance with statistical analysis and contributed to the writing of the article.

  • Funding (1) The Twohey Grant, University of Leeds, (2) Liverpool Women's Newborn Appeal and (3) Leeds Teaching Hospitals charity fund.

  • Competing interests None declared.

  • Ethics approval Ethical approval was granted prior to the initiation of the study by the NRES Committee London—Brent.

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

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