When Meijin Hsiao ’26 (NUR) started to seriously consider a career in medicine, she felt a calling to care for older adults in the field of geriatrics. Simply put, she says, the elderly shouldn’t be left behind.
Now, as she finishes a research summer focused on newborns and the labor and delivery nurses who help bring them into the world, she says she’s drawn to the field that cares for those when they take their first breath.
But her reasoning circles back to that original desire to serve the oldest among us.
“Babies are the future. They’re the next generation and the ones we rely on as we age. We need babies to be healthy and grow into strong adults who can take care of us when we’re older,” she says. “They’re supposed to move society to the next level, create new ideas, and make humankind even stronger.”
It’s why her summer research project, which received support from a Summer Undergraduate Research Fund (SURF) award through the Office of Undergraduate Research, studied pharmaceutical methods of neonatal resuscitation and ways to streamline what many nurses describe as a complicated process.
“This is not just a regular Honors project in my heart,” Hsiao says. “This is something that could benefit everyone, including future babies.”
The School of Nursing junior who started her clinical rotations this semester but has been working at the Hospital of Central Connecticut in New Britain for nearly two years, surveyed registered nurses and nurse practitioners from throughout the state on their secondary traumatic stress during neonatal resuscitation.
The project was sparked by a conversation with her advisor, Carrie Eaton, about how stressful the process of neonatal resuscitation is for nurses, who are the ones in the delivery room charged with performing the procedure.
When necessary, nurses perform manual CPR on newborns, including chest compressions and giving breaths, Hsiao explains, and when that doesn’t work, they move to pharmaceutical intervention by administering a stimulant to restart the heart.
To determine how much epinephrine, the drug that’s most commonly used, to give the baby, they first need to determine the baby’s birth weight with the umbilical cord not yet cut to estimate the fetal weight.
Simultaneously, in this complex process that requires exceptional teamwork, the nurse assists the resuscitation team with access for medication administration. They also must calculate the correct dose of epinephrine in milligrams per kilogram based on the baby’s weight and then convert it to milliliters for administration – all under intense pressure.
They turn to a flow chart and use the information to figure out the correct dose, she adds. It’s this flow chart she’s most critical of because using it can be a cumbersome challenge in a time of urgency.
Further, there are multiple brands of epinephrine sold to hospitals with each having their own adaptors and connectors to draw up the medication, along with different dosages based on whether it’s administered intravenously or via endotracheal tube.
What’s more, nurses don’t necessarily know which brand is at the ready because it can’t be opened until they need it, making each situation even more unique.
“It’s stressful on the nurses because of what they’re dealing with, but it’s also stressful on the parents. It’s scary to see your child resuscitated right after birth,” Hsiao says. “It’s a heartbreaking scene, and in the free response part of my survey, some labor and delivery nurses mentioned that the toughest part is when the parents see all this happening and they’re not able to provide any comfort or consolation.”
About 10% of newborns require resuscitation. Sometimes it’s unexpected and happens in an uncomplicated pregnancy. Other times the medical team may consider it a probability, as in the case of a pre-term delivery.
Hsiao says her research shows that while all this is happening – in a space of about two minutes, because each second without oxygen can be detrimental – nurses are assessing whether they’ll need to use other pharmaceuticals to counteract a drug or multiple drugs that could have been passed from mother to baby.
“Babies are so delicate,” she says, “to the point that during CPR you can’t even squeeze the air bag too much because their lungs will inflate too far. They have weaker rib cages when doing compressions, and they breathe faster than adults, so their lungs need to be inflated more frequently.”
Hsiao says many of the nurses who filled out her survey indicated they also dread neonatal resuscitation because they don’t have much experience with it. Some hospitals have dedicated teams on standby for emergencies, and nurses who work in the NICU, or neonatal intensive care units, also are well versed. But nurses at small or rural hospitals might seldom need to use it.
Skills get rusty, despite regular training that might be only adequate to begin with, Hsiao adds.
“My heart just broke when I read some of the deeply personal stories from the nurses who participated in the survey,” she says. “I don’t like hearing about babies dying, and I want to prevent that.”
For Hsiao that starts with studying the nursing experience and one day suggesting ways to improve the dosage chart, so more babies can survive.
“To be honest, my parents wanted me to become an MD, but I like nursing because of the patient care side of it,” she says. “Doctors treat the disease, but nurses treat the patient, and I want a connection with my patients. I can’t see myself not going into nursing, it was just a calling.”
Her senior year in 2025-26 will bring a labor and delivery clinical rotation, and for her capstone rotation she says she’s likely to look for a NICU placement.
“I love babies. I’ve always loved babies,” Hsiao says, recalling that the first baby she ever held was her cousin when she was 8 and visiting family in Vietnam. “It just instantly clicked with me once my aunt gave me my cousin to hold. It was so easy. I instantly knew what to do with her in my arms. It was a special feeling.”
