SCORING The debrief now scores what the baby needed rather than what was attempted. An intervention that was indicated but not delivered counts against the score instead of being left out of it — previously, skipping something could score better than doing it imperfectly. Ventilation, chest compressions and adrenaline are treated as critical actions. Not delivering one when it was indicated caps the overall score, and the debrief states which action it was and the time it became indicated. Unnecessary adrenaline, compressions, UVC insertion, intubation and needle decompression are now grouped as safety events rather than sitting among the checklist items. Earlier scores are unchanged and remain in the training log. Sim of the Day percentiles are compared within a scoring version, so earlier scores are not ranked against the new ones. SELF-INFLATING BAG Sims can now be authored with a self-inflating bag in place of a T-piece resuscitator. Inflations are delivered by squeezing the bag; rate, depth and inspiratory time reflect the squeeze. The pressure-relief valve is set at 35 cmH₂O and can be held shut where higher pressures are required. The bag delivers no PEEP. An oxygen reservoir can be fitted and removed during the sim. Reservoir fill is integrated from delivered flow and modulates delivered FiO₂ below the source gas. Delivered FiO₂ from the bag is derived from published bench measurements in neonatal self-inflating bags (Sasi et al., J Paediatr Child Health 2013). On 100% source gas without a reservoir it is approximately 75% at 1 L/min and plateaus near 94%; the commonly taught 40% is reached only at about 0.2 L/min (which cannot be delivered on the installed flow meter) Fixed bug where the chest did not move during bag inflations. Delivered tidal volume, scoring and the infant's response were correct throughout — only the chest movement was missing, so effective ventilation could read as ineffective. OXYGEN CYLINDER SUPPLY Gas supply is authored independently of the device, so either a T-piece or a bag may run on blended gas or on a cylinder. Where a cylinder is used there is no blender and flow rate is the only oxygen control: contents deplete with use, delivered flow tapers below 20 bar, and a spent cylinder can be exchanged mid-sim. TRANSILLUMINATION The cold light glow is smaller, brighter and less red, so it reads against well-perfused skin rather than only against a cyanosed chest. Saturated red is now reserved for the affected hemithorax under tension pneumothorax, widening the contrast between sides. Fixed bug where transillumination wand disappeared behind the chest. OTHER CHANGES - Laryngeal mask (i-gel) insertion is animated through the full placement sequence. - Subcostal recession intensity scales with central respiratory effort, not chest wall movement alone. - Reduced chest excursion for normal spontaneous breathing. - Solo sims no longer end early while a pneumothorax is being assessed with the cold light. - Shared sim links can be set to last up to six months and have no limit on the number of plays. An expired link now names the sim and who sent it.

SELF-INFLATING BAG Sims can now be authored with a self-inflating bag in place of a T-piece resuscitator. Inflations are delivered by squeezing the bag; rate, depth and inspiratory time reflect the squeeze. The pressure-relief valve is set at 35 cmH₂O and can be held shut where higher pressures are required. The bag delivers no PEEP. An oxygen reservoir can be fitted and removed during the sim. Reservoir fill is integrated from delivered flow and modulates delivered FiO₂ below the source gas. Delivered FiO₂ from the bag is derived from published bench measurements in neonatal self-inflating bags (Sasi et al., J Paediatr Child Health 2013). On 100% source gas without a reservoir it is approximately 75% at 1 L/min and plateaus near 94%; the commonly taught 40% is reached only at about 0.2 L/min (which cannot be delivered on the installed flow meter) OXYGEN CYLINDER SUPPLY Gas supply is authored independently of the device, so either a T-piece or a bag may run on blended gas or on a cylinder. Where a cylinder is used there is no blender and flow rate is the only oxygen control: contents deplete with use, delivered flow tapers below 20 bar, and a spent cylinder can be exchanged mid-sim. TRANSILLUMINATION The cold light glow is smaller, brighter and less red, so it reads against well-perfused skin rather than only against a cyanosed chest. Saturated red is now reserved for the affected hemithorax under tension pneumothorax, widening the contrast between sides. Fixed bug where transillumination wand disappeared behind the chest. OTHER CHANGES - Laryngeal mask (i-gel) insertion is animated through the full placement sequence. - Subcostal recession intensity scales with central respiratory effort, not chest wall movement alone. - Reduced chest excursion for normal spontaneous breathing. - Solo sims no longer end early while a pneumothorax is being assessed with the cold light.

SELF-INFLATING BAG Sims can now be authored with a self-inflating bag in place of a T-piece resuscitator. Inflations are delivered by squeezing the bag; rate, depth and inspiratory time reflect the squeeze. The pressure-relief valve is set at 35 cmH₂O and can be held shut where higher pressures are required. The bag delivers no PEEP. An oxygen reservoir can be fitted and removed during the sim. Reservoir fill is integrated from delivered flow and modulates delivered FiO₂ below the source gas. Delivered FiO₂ from the bag is derived from published bench measurements in neonatal self-inflating bags (Sasi et al., J Paediatr Child Health 2013). On 100% source gas without a reservoir it is approximately 75% at 1 L/min and plateaus near 94%; the commonly taught 40% is reached only at about 0.2 L/min. OXYGEN CYLINDER SUPPLY Gas supply is authored independently of the device, so either a T-piece or a bag may run on blended gas or on a cylinder. Where a cylinder is used there is no blender and flow rate is the only oxygen control: contents deplete with use, delivered flow tapers below 20 bar, and a spent cylinder can be exchanged mid-sim. OTHER CHANGES - Laryngeal mask (i-gel) insertion is animated through the full placement sequence. - Subcostal recession intensity scales with central respiratory effort, not chest wall movement alone. - Reduced chest excursion for normal spontaneous breathing.

The 2.7 series brings neoSim's biggest visual upgrade yet, plus more realistic physiology. A new 3D chest • A true 3D torso replaces the flat manikin — lifelike chest rise, indrawing and colour change. • "Cold Light" transillumination now shines applied via a "wand" not your finger-tip for better visibility, with the affected side glowing red under a tension pneumothorax. Smarter thermoregulation • Plastic wrap now properly keeps preterm babies warm — and is offered for any baby under 1500 g. • Cold babies now show depressed breathing (apnoea when severe), reversing on rewarming. • Overheating now behaves realistically by gestation.

• Meet the new 3D newborn — a fully three-dimensional chest that rises, retracts and changes colour in real time, so every breath, compression and intervention feels true to life. • Cold Light transillumination now uses a handheld wand — your finger no longer blocks the glow when localising a pneumothorax, with cleaner, more realistic light. • Tension pneumothorax — the affected side now shows subtle chest movement and indrawing instead of sitting frozen, recovering as you decompress. • Refined scoring for chest-compression response. • Stability and polish.

Meet the new 3D ventilation sim model! A sculpted, shaded 3D newborn that breathes with your ventilation — cyanosis, subcostal recession and chest asymmetry rendered live More realistic chest-rise and lung mechanics, including over-bagging and true expiratory timing 3D transilluminate to diagnose a tension pneumothorax, then needle-decompress New respiratory-effort control when you build your own sims Your CPD training log now restores your name and achievement tiers automatically after reinstalling or signing in on a new device Numerous realism, scoring and stability improvements3D chest — the baby's chest is now a detailed 3D model, with more lifelike breathing and clearer clinical signs: chest rise, subcostal/intercostal recession, and pneumothorax findings all read more realistically. Prefer the classic look, or on an older device? Settings → Display → 3D chest switches back to the 2D view. More realistic fluid physiology — over-transfusion now reflects circulatory overload, with pulmonary oedema worsening oxygenation. Airway fix — fixed a bug exposed if nCPAP commenced during intubation attempt Polish — smoother transillumination when checking for pneumothorax, a corrected UVC catheter tip position, and refined pneumothorax chest signs.

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