Key messages
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Newborn resuscitation training (NRT) programmes may decrease newborn deaths in the first 28 days after birth, mainly during the first 24 hours and the first 7 days after birth.
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Studies are still needed to find out whether NRT decreases brain injury or long-term developmental difficulties in babies after resuscitation.
How important is training in resuscitation at birth?
Newborns may need resuscitation (first aid given when breathing or a heartbeat is absent or not adequate) at birth. About 1 in 10 term newborns only need simple actions, such as drying and stimulation, to start breathing. About 1 in 20 need additional support, including assisted breathing. An even smaller number of newborns need more intensive measures, such as a breathing tube, chest compressions, or emergency medicines. Differences in babies' health can affect how well they respond to resuscitation. For example, babies born too early are more likely to need medical help at birth, such as help with breathing or other lifesaving care.
There are many different newborn resuscitation training (NRT) programmes that target healthcare providers, including doctors, midwives, nurses, and others. Whether these training programmes decrease newborn deaths or prevent brain injury or long-term developmental difficulties from lack of oxygen has not been studied. Our review in 2015 found a decrease in newborn deaths after training, but no studies looked at brain injury or developmental difficulties. In this update, we wanted to know if new studies support our findings of decreased newborn deaths and whether any studies reported on brain injury and long-term developmental difficulties.
What did we want to find out?
We wanted to find out if NRT programmes decrease deaths in the first 28 days after birth, including deaths in the first 24 hours, the first 7 days, and between 8 and 28 days after birth, and if NRT programmes decrease the chances of brain injury or long-term developmental difficulties in babies.
What did we do?
We searched for studies that looked at resuscitation training for healthcare providers, including doctors, midwives, nurses, and others who attend deliveries. We included studies that reported on newborn deaths and/or brain injury or developmental difficulties. We looked at studies that compared NRT programmes with no training or with very basic training. We also looked at studies that compared NRT programmes alone with NRT programmes with extra components, such as refresher (booster) training.
We compared and summarised the results of the studies and rated our confidence in the evidence based on factors such as study methods and sizes.
What did we find?
Although we included 27 studies (528,366 newborns) in this review, only 1 to 4 studies contributed to any given result.
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Evidence from studies in low-resource settings suggests that NRT, compared with no training, likely decreases newborn deaths in the first 24 hours and 7 days of life.
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Evidence from studies in low-resource settings suggests that NRT, compared with very basic training, may decrease newborn deaths in the first 28 days of life and likely decreases newborn deaths in the first 24 hours and 7 days of life. NRT, compared with very basic training, may not decrease newborn deaths between 8 and 28 days of life.
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The evidence is very uncertain whether NRT with booster training affects newborn deaths in the first 28 days of life.
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No studies looked at whether NRT decreases brain injury or long-term developmental difficulties in babies after resuscitation.
What are the limitations of the evidence?
We have moderate to very low confidence in the evidence. Our confidence in the evidence is limited because the studies involved different types of participants and different types of interventions. Also, only a small number of studies contributed to each result; people in the studies knew which treatment they received; and some people in the studies were lost during follow-up. Most studies were done in low-resource settings, so their results may not apply to high-resource settings like developed countries.
How up-to-date is this evidence?
This review updates our previous review. The evidence is current to June 2025.
Pročitajte cijeli sažetak
Approximately 10% of all newborns require resuscitation at birth. Training healthcare providers in standardised formal neonatal resuscitation training (SFNRT) programmes may improve neonatal outcomes. Substantial healthcare resources are expended on SFNRT.
Ciljevi
To determine whether SFNRT programmes reduce neonatal mortality and morbidity, improve teamwork behaviour, or improve acquisition and retention of knowledge and skills.
Metode pretraživanja
We searched CENTRAL, MEDLINE, three other databases, and two trial registers, together with reference checking, citation and errata/retractions checking, to identify studies for inclusion in the review. The latest search date was June 2025.
Kriteriji odabira
Randomised or quasi-randomised trials including cluster-randomised trials, comparing a SFNRT with no SFNRT, additions to SFNRT or types of SFNRT, and reporting at least one of our specified outcomes.
Prikupljanje podataka i obrada
Two authors extracted data independently and performed statistical analyses including typical risk ratio (RR), risk difference (RD), mean difference (MD), and number needed to treat for an additional beneficial outcome (NNTB) or an additional harmful outcome (NNTH) (all with 95% confidence intervals (CI)). We analysed cluster-randomised trials using the generic inverse variance and the approximate analysis methods.
Glavni rezultati
We identified two community-based and three manikin-based trials that assessed the effect of SFNRT compared with no SFNRT. Very low quality evidence from one study suggested improvement in acquisition of knowledge (RR 5.96, 95% CI 3.60 to 9.87) and skills (RR 170, 95% CI 10.8 to 2711) and retention of knowledge (RR 3.60, 95% CI 2.43 to 5.35) and the other study suggested improvement in resuscitation and behavioural scores.
We identified three community-based cluster-randomised trials in developing countries comparing SFNRT with basic resuscitation training (Early Newborn Care). In this setting, there was moderate quality evidence that SFNRT decreased early neonatal mortality (typical RR 0.88, 95% CI 0.78 to 1.00; 3 studies, 66,162 neonates) and when analysed by the approximate analysis method (typical RR 0.85, 95% CI 0.75 to 0.96; RD -0.0044, 95% CI -0.0082 to -0.0006; NNTB 227, 95% CI 122 to 1667). Low quality evidence from one trial showed that SFNRT may decrease 28-day mortality (typical RR 0.55, 95% CI 0.33 to 0.91) but the effect on late neonatal mortality was more uncertain (typical RR 0.47, 95% CI 0.20 to 1.11). None of our a priori defined neonatal morbidities were reported. We did not identify any randomised studies in the developed world.
We identified two trials that compared SFNRT with team training to SFNRT. Teamwork training of physician trainees with simulation may increase any teamwork behaviour (assessed by frequency) (MD 2.41, 95% CI 1.72 to 3.11) and decrease resuscitation duration (MD -149.54, 95% CI -214.73 to -84.34) but may lead to little or no difference in Neonatal Resuscitation Program (NRP) scores (MD 1.40, 95% CI -2.02 to 4.82; 98 participants, low quality evidence).
We identified two trials that compared SFNRT with booster courses to SFNRT. It is uncertain whether booster courses improve retention of resuscitation knowledge (84 participants, very low quality evidence) but may improve procedural and behavioural skills (40 participants, very low quality evidence).
We identified two trials on decision support tools, one on a cognitive aid that did not change resuscitation scores and the other on an electronic decision support tool that improved the frequency of correct decision making on positive pressure ventilation, cardiac compressions and frequency of fraction of inspired oxygen (FiO2) adjustments (97 participants, very low quality evidence).
Zaključak autora
SFNRT, compared with no training, likely decreases mortality at 24 hours of life and in the first 7 days of life. SFNRT, compared with basic resuscitation training, may decrease mortality in the first 28 days of life, likely decreases mortality at 24 hours and 7 days of life, but may not decrease late neonatal mortality. The evidence is very uncertain whether SFNRT with boosters affects mortality in the first 28 days of life. This update confirms our 2015 review findings of decreased neonatal mortality, but did not identify any reports on neonatal morbidity, particularly hypoxic ischaemic encephalopathy and neurodevelopmental outcomes.
Funding
This Cochrane review had no dedicated funding.
Registration
Protocol (2011) DOI: 10.1002/14651858.CD009106. Original review (2015) DOI: 10.1002/14651858.CD009106.pub2.
