Nasal CPAP: choose nasal CPAP for preterm RDS instead of mask PPV. Available for babies ≤32 weeks. LISA (Less Invasive Surfactant Administration): give surfactant via thin catheter without intubating. Tap Surfactant with no ETT in place to start LISA; with an ETT in, it gives the INSURE dose. Ability to bail out of LISA if infant unstable Failed intubation: pick a tube that's too large for the baby and you'll now see the attempt play through: blade in, tube enters, tube withdraws, advisory across the top. Code button: bell glyph plus a clearer red-to-green colour change when help has been called. Vagal HR drop while the laryngoscope blade is in the airway.

Sim Builder — refinements Sim Builder (the Design & Share Your Own Sims feature added in 2.5.0) lets you author and share custom resuscitation scenarios. Three fidelity issues are resolved this release. Custom sims with high airway obstruction now actually obstruct ventilation as authored — previously, even setting obstruction to 100 % silently rolled through to zero. Meconium aspirate is now clearly visible during suction: the catheter darkens to a near-black column as you suction, with intensity scaled to the obstruction level. And the PPHN checkbox now produces clinically visible PPHN behaviour at any lactate — previously it had no effect on babies authored at modest lactate. A well term baby with PPHN at lactate 2 now reads as the classic teaching presentation: SpO₂ around 88 % on room air, climbing to ~97 % on 30 % O₂ Newborn breathing patterns: Babies described as breathing regularly at birth no longer appear apnoeic on arrival at the warmer. The brainstem drive model has been retuned so that a well term baby in the transitional first-minute window — typical SpO₂ in the 50s, mild lactate — visibly breathes rather than presenting at the borderline of apnoea. Extreme preterms without asphyxia continue to present with the expected immature pattern — apnoea or minimal respiratory effort at the same saturations. Gasping, when it occurs, now reads as a depressed-but-visible pattern (6–20 /min) rather than once-every-15-seconds. Early-sim fairness floor In the first 3 minutes, a competent NRP-style resuscitation now has a soft floor on SpO₂ so the engine's feedback loops can't compound into a non-survivable state when the team is doing the right thing. The floor activates only when ventilation is effective, FiO₂ is fully escalated, and if HR is below 60) compressions are running. Fades out before the 3-minute mark so the underlying physiology asserts after the resuscitation window. Stability Several quieter fixes including a refactor that closes a class of parity bugs between iOS and the engine, an Xcode build script that self-heals on machines without node in the default path, and tighter tuning across the meconium suction animation on both iOS and the web team mode.

Design and share your own sims You can now author custom resuscitation cases from scratch. Tap "Design & Share Your Own Sims" on the home screen to set gestation, weight, severity, antenatal history, equipment startup state and more, then test your case before saving. A Saved Sims list lets you revisit, rename, duplicate, edit, or delete anything you've authored. From the same list, tap Share to generate a link your colleagues can open in any browser — no app or account needed on their end. Set play caps (up to 40) and expiry (up to 14 days), and override the title shown to recipients if your working name isn't what you want them to see. Recipients get a short preview page with the case vignette before they tap Play. Asymmetric pneumothorax visuals Pneumothorax scenarios now show asymmetric subcostal indrawing — the healthy side does the extra work and the affected side stays quiet, matching real-world clinical signs. The transilluminator glow fades smoothly across the midline and the diaphragm rather than stopping at a sharp line. Live pre-warmer banner for authored sims For sims you've designed, the banner across the pre-warmer / cord-clamp window updates with live engine state — tone, breathing, and pallor reflect physiology as the case evolves toward warmer arrival. Stability + scoring Several fixes to saved-sim playback (including older records without form state), share-link reliability, and edge-case scoring for cord clamp and flow rate.

Share sims with colleagues or trainees via secure browser links (capped by play count + expiry; sign-in required to create). Restored intended airway-obstruction profile for built-in MAS scenarios (was silently disabled on iOS). Esophageal intubation: placement recognition, scoring, re-intubation flow. T-piece physics: more accurate tidal volume and mean airway pressure under leak. ETT adrenaline pathway: animation + route-aware pharmacology. PEEP range widened to 0–20 cmH₂O with quadratic pneumothorax risk above 5. AI debrief not offered when your device is offline. Numerous smaller engine and UI refinements.

Three-tier credentials — Earn Code Team, Advanced, and Specialist badges as you master scenarios. Your debrief now shows exactly what's left for the next tier. Esophageal intubation recognition — ETTs can land in the esophagus, just like in real life. Spot the signs — no chest rise, no CO₂ — and reposition. A new scoring item rewards fast recognition. ETT size matters — Pick the wrong size and you'll fail to intubate. Right-sized tubes seal better. ETT adrenaline route — Give adrenaline down the ETT when there's no umbilical access. The engine models slower, less reliable absorption. Better chest recession animation Refined T-piece physics — Manometer shows the realistic peak pressure actually being delivered under leak. PEEP range widened Polish — Surfactant administration with proper T-piece detachment, clearer cord clamp message, ELBW transilluminator tuning, fairer airway scoring, and many smaller refinements.

Bug fix Improved accuracy of post-transfusion Hb

More accurate ventilation modelling

Refined pneumothorax trigger physiology Improved chest rise accuracy across weight ranges Minor UI improvement Various engine tuning improvements

Improved iPad support with adaptive layout and docked advanced equipment panel. Improved readability on smaller screens.

Mean airway pressure now drives oxygenation — PIP, PEEP, and Ti combinations affect SpO2 more realistically Esophageal intubation can occur on ~5% of ETT attempts — recognise via no chest rise, falling SpO2, no CO2 detection Refined RDS, MAS, and ELBW preterm physiology to match clinical trajectories more closely Minor scoring fix for initial FiO2 selection Subcostal recession fix Flow meter track and manometer rise speed fixes

Set up heater, FiO2, PIP, PEEP and flow before the baby arrives — matches real NRP workflow Pulse-oximeter beep with adjustable volume Tutorial: clearer pacing with blocking helper modals before each step Refined AI debrief tone and length Fixed extubation, suction, and surfactant animations