Development and validation of a Neonatal Birth Readiness Assessment Tool (Neo-BRAT) for paediatric residents: a mixed-methods validation study

Background Effective neonatal resuscitation requires timely preparation, appropriate equipment checks and coordinated team readiness prior to birth. Existing neonatal resuscitation assessments primarily evaluate technical performance after birth and do not systematically assess readiness and preparation before delivery. There is a need for a practical, standardised tool to assess and improve neonatal birth preparedness in clinical settings. Innovation We developed the Neonatal Birth Readiness Assessment Tool (Neo-BRAT), a structured workplace-based assessment designed to evaluate predelivery preparedness for neonatal resuscitation across key domains including initial assessment, thermoregulation, airway preparation and respiratory support. Methods An exploratory, sequential, mixed-methods tool validation study was conducted at the Department of Paediatrics, Aga Khan University Hospital, Pakistan. Content validity was established using a modified Delphi process involving neonatologists, paediatricians, nurses and medical education experts. Construct validity was assessed using exploratory factor analysis. Three independent raters assessed 41 paediatric residents through simulation-based assessments using the 13-item Neo-BRAT across four domains. Internal consistency (Cronbach’s alpha), inter-rater reliability (intraclass correlation coefficient (ICC)) and known-groups validity (junior vs senior residents) were analysed. Results All items demonstrated excellent content validity (Item-level Content Validity Index and Scale-level Content Validity Index Average method=1.0). The tool showed good internal consistency (Cronbach’s alpha=0.796) and acceptable inter-rater reliability (ICC=0.735). Senior residents scored significantly higher than junior residents on several key preparedness items and on overall mean scores (p=0.002). Conclusions Neo-BRAT offers a structured approach for formative assessment of delivery room preparedness in simulation-based training and competency-based education.