Newborn Resuscitation Training Programmes Reduce Early Neonatal Mortality

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.