Newborn Resuscitation Training Programmes Reduce Early Neonatal Mortality

Abstract

Background: Substantial health care resources are expended on standardised formal neonatal resuscitation training (SFNRT) programmes, but their effectiveness has not been proven. Objectives: To determine whether SFNRT programmes reduce neonatal mortality and morbidity, improve acquisition and retention of knowledge and skills, or change teamwork and resuscitation behaviour. Methods: We searched CENTRAL, MEDLINE, PREMEDLINE, EMBASE, CINAHL, Web of Science and the Oxford Database of Perinatal Trials, ongoing trials and conference proceedings in April 2015, and included randomised or quasi-randomised trials that reported at least one of our specified outcomes. Results: SFNRT in low- and middle-income countries decreased early neonatal mortality [risk ratio (RR) 0.85 (95% CI 0.75-0.96)]; the number needed to treat for benefit [227 (95% CI 122-1,667; 3 studies, 66,162 participants, moderate-quality evidence)], and 28-day mortality [RR 0.55 (95% CI 0.33-0.91); 1 study, 3,355 participants, low-quality evidence]. Decreasing trends were noted for late neonatal mortality [RR 0.47 (95% CI 0.20-1.11)] and perinatal mortality [RR 0.94 (95% CI 0.87-1.00)], but there were no differences in fresh stillbirths [RR 1.05 (95% CI 0.93-1.20)]. Teamwork training with simulation increased the frequency of teamwork behaviour [mean difference (MD) 2.41 (95% CI 1.72-3.11)] and decreased resuscitation duration [MD -149.54 (95% CI -214.73 to -84.34); low-quality evidence, 2 studies, 130 participants]. Conclusions: SFNRT in low- and middle-income countries reduces early neonatal mortality, but its effects on birth asphyxia and neurodevelopmental outcomes remain uncertain. Follow-up studies suggest normal neurodevelopment in resuscitation survivors.

Improved postnatal care is needed to maintain gains in neonatal survival after the implementation of the Helping Babies Breathe initiative

“…Of these deaths, 2.6 million are classified as stillbirths and 2.9 million occur during the neonatal period (1). Training in neonatal resuscitation has the potential to significantly reduce both intrapartumrelated stillbirths and neonatal mortality (3,4). Training in neonatal resuscitation has the potential to significantly reduce both intrapartumrelated stillbirths and neonatal mortality (3,4).…”

Effect of a Low-Dose/High-Frequency Training on Real-Life Neonatal Resuscitation in a Low-Resource Setting

“…Bellad et al [23] showed that HBB training was not associated with consistent improvements in mortality rates among all neonates ≥1,500 g in India and Kenya. The implementation of quality improvement interventions and low-dose/ high-frequency training including in situ simulation may facilitate the transfer of new knowledge/skills into clinical practice, thereby reducing perinatal mortality in Tanzania, Nepal and Sudan [7,15,24].…”

“…Neonatal resuscitation has gathered considerable attention, with the Neonatal Resuscitation Program (NRP) [4] and Helping Babies Breathe (HBB) [5] being taught in over 100 countries. Despite increasing information on resuscitation training in low-resource settings [6,7], the most efficient and effective ways for health care workers to acquire and maintain neonatal resuscitation skills are still undefined [8]. In addition, incorrect, ineffective or dangerous forms of practice are actually widespread [1,9].…”

Helping babies breathe can reduce deaths with the right combination of training and expertise

“…A systematic review calculated that if every birth was attended by someone who had undergone standardised formal neonatal training, 140 000 lives would be saved each year (3). This huge figure shows that major reductions in neonatal mortality are possible in those parts of the world with the highest perinatal mortalities, such as sub-Saharan Africa.…”

“…Other studies have been reassuring about morbidity rates, as they have shown that babies who needed resuscitation from low-income and middle-income countries did not have an excess of neurological or developmental morbidity at 12 months of age (9,10). More research, however, is needed to understand the long-term effect of resuscitation programmes in the context of babies with birth asphyxia and subsequent neonatal encephalopathy (3).…”