Introduction: Approximately 10% of neonates require stabilization at birth, with 5% needing positive pressure ventilation (PPV). Despite its criticality , airway obstruction and mask leaks remain common even among experienced providers, highlighting a need for regular skill evaluation and reinforcement. Objectives: To assess adherence to neonatal ventilation guidelines via simulation, evaluate baseline performance, provide structured feedback with targeted education, and measure skill improvement after six weeks. Methodology: This prospective audit included 53 healthcare workers at DeSoysa Maternity Hospital. Participants managed simulated resuscitation scenarios assessed by three evaluators using standardized checklists. Following immediate feedback and hands-on training, 45 participants were reassessed six weeks later. Results: Baseline performance was suboptimal; no participant demonstrated full competency .Initial scores for neutral head position (50.9%), jaw thrust (11.3%), oral airway insertion (22.6%), mask size selection (75.5%), and C&E grip (28.3%) were low . Correct PIP/PEEP settings (37 .7–41.5%) and ventilation breaths (5.7%) were also inadequate. Reassessment showed marked improvements: neutral position rose to 91.1%, jaw thrust to 55.5%, and oral airway insertion to 100%. Mask size and oxygen flow settings reached 100%, while PIP/PEEP accuracy rose to 82.2%. Correct ventilation breaths improved to 44.4%, and overall full competency increased from 0% to 26.6%. Conclusion: Baseline neonatal airway skills were inadequate. Simulation-based training with structured feedback significantly improved performance across all domains. Regular, systematic reassessment is essential to sustain these life-saving competencies and optimize neonatal outcomes.