575 - Standardised formal resuscitation training programmes for reducing mortality and morbidity in newborn infants

Publication Number: 3556.575

Nicole Neveln, Baylor College of Medicine, Houston, TX, United States; Robert Joyce, National Maternity Hospital, Dublin, Dublin, Ireland; Eugene Dempsey, University Colleeg Cork, Cork, Cork, Ireland; Michelle Fiander, Cochrane Neonatal Group, Halifax, NS, Canada; Keith J. Barrington, Université de Montréal, Montréal, PQ, Canada; Mohan Pammi, Baylor College of Medicine, Bellaire, TX, United States

Background: Approximately 10% of all newborns require resuscitation at birth. Training healthcare providers in standardised
formal neonatal resuscitation training (SFNRT) programmes may improve neonatal outcomes.

Objective: To determine whether SFNRT programmes reduce neonatal mortality and morbidity, improve acquisition and
retention of knowledge and skills, or change teamwork and resuscitation behavior.

Design/Methods: We performed the systematic review following Cochrane methodology. We searched databases and trial registers in June 2025. We assessed risk of bias with the RoB 1 tool. We used the fixed-effect model for meta-analysis and reported risk ratio (RR), risk difference (RD), mean difference (MD), and number needed to treat (all with 95% confidence intervals (CI)). We used GRADE to assess certainty of evidence for each outcome.

Results: We included 27 studies (528,366 live born). SFNRT was compared with a) no SFNRT; b) basic resuscitation training; c) SFNRT with additional team training; d) SFNRT with boosters; and e) SFNRT with added educational components. SFNRT compared to no training, results in a reduction in 24-hour mortality (RR 0.73, 95% CI 0.66 to 0.82; I² = 0%; 2 studies, 353,527 participants; moderate-certainty evidence) and early (7-day) mortality (RR 0.82, 95% CI 0.75 to 0.89; I² = 0%; 2 studies, 354,358 participants; moderate-certainty evidence). SFNRT compared with basic training decreases neonatal (28-days) mortality (RR 0.55, 95% CI 0.33 to 0.91; I² not applicable; 1 study, 3355 participants; low-certainty evidence). Teamwork training may improve teamwork behavior (MD 2.60, 95% CI 1.93 to 3.27; I² = 46%; 3 studies, 238 participants; low-certainty evidence) and decrease resuscitation duration (MD −149.54, 95% CI −214.73 to −84.34; I² = 0%; 2 studies, 130 participants; low-certainty evidence). The evidence is uncertain whether boosters or audiovisual aids improve acquisition and retention of knowledge and skills.

Conclusion(s): Moderate to low certainty evidence suggests that SFNRT decreases 24 hr, early neonatal and neonatal mortality. Incorporating additional training into SFNRT may enhance teamwork behavior and resuscitation performance. Randomised trials of SFNRT should report on neonatal morbidity, including hypoxic ischemic encephalopathy, and neurodevelopmental outcomes.
This abstract is based on a pre-peer review version of a Cochrane review. Upon acceptance, we anticipate publication in the Cochrane Database of Systematic Reviews.

SFNRT decreases 24 hr neonatal mortality
Comparison of SFNRT with no SFNRT

SFNRT decreases early neonatal (7 day) mortality
SFNRT compared to no SFNRT

SFNRT may decrease neonatal mortality (at 28 days)
SFNRT compared to basic resuscitation training may improve neonatal mortality (28 days)