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. 2017 Nov 16;1(1):e000183.
doi: 10.1136/bmjpo-2017-000183. eCollection 2017.

Impact of neonatal resuscitation trainings on neonatal and perinatal mortality: a systematic review and meta-analysis

Archana Patel  1 , Mahalaqua Nazli Khatib  2 , Kunal Kurhe  1 , Savita Bhargava  1 , Akash Bang  3
Affiliations

Impact of neonatal resuscitation trainings on neonatal and perinatal mortality: a systematic review and meta-analysis

Archana Patel et al. BMJ Paediatr Open. .

Abstract

Background: Training of birth attendants in neonatal resuscitation is likely to reduce birth asphyxia and neonatal mortality. We performed a systematic review and meta-analysis to assess the impact of neonatal resuscitation training (NRT) programme in reducing stillbirths, neonatal mortality, and perinatal mortality.

Methods: We considered studies where any NRT was provided to healthcare personnel involved in delivery process and handling of newborns. We searched MEDLINE, CENTRAL, ERIC and other electronic databases. We also searched ongoing trials and bibliographies of the retrieved articles, and contacted experts for unpublished work. We undertook screening of studies and assessment of risk of bias in duplicates. We performed review according to Cochrane Handbook. We assessed the quality of evidence using the GRADE approach.

Results: We included 20 trials with 1 653 805 births in this meta-analysis. The meta-analysis of NRT versus control shows that NRT decreases the risk of all stillbirths by 21% (RR 0.79, 95% CI 0.44 to 1.41), 7-day neonatal mortality by 47% (RR 0.53, 95% CI 0.38 to 0.73), 28-day neonatal mortality by 50% (RR 0.50, 95% CI 0.37 to 0.68) and perinatal mortality by 37% (RR 0.63, 95% CI 0.42 to 0.94). The meta-analysis of pre-NRT versus post-NRT showed that post-NRT decreased the risk of all stillbirths by 12% (RR 0.88, 95% CI 0.83 to 0.94), fresh stillbirths by 26% (RR 0.74, 95% CI 0.61 to 0.90), 1-day neonatal mortality by 42% (RR 0.58, 95% CI 0.42 to 0.82), 7-day neonatal mortality by 18% (RR 0.82, 95% CI 0.73 to 0.93), 28-day neonatal mortality by 14% (RR 0.86, 95% CI 0.65 to 1.13) and perinatal mortality by 18% (RR 0.82, 95% CI 0.74 to 0.91).

Conclusions: Findings of this review show that implementation of NRT improves neonatal and perinatal mortality. Further good quality randomised controlled trials addressing the role of NRT for improving neonatal and perinatal outcomes may be warranted.

Trial registration number: PROSPERO 2016:CRD42016043668.

Keywords: health services research; mortality; multidisciplinary team-care.

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Conflict of interest statement

Competing interests: The authors AP and AB were investigators in two of the studies (Bellad et al and Patel et al) included in the meta-analysis. There were no other competing interest.

Figures

Figure 1
Figure 1
Flow diagram of the study selection process. NRP, Neonatal Resuscitation Program.
Figure 2
Figure 2
Forest plot comparing all SB between the NRT and the control groups. NRT, neonatal resuscitation training; SB, stillbirths.
Figure 3
Figure 3
Forest plot comparing 7-day neonatal mortality between the NRT and the control groups. NRT, neonatal resuscitation training.
Figure 4
Figure 4
Forest plot comparing 28-day neonatal mortality between the NRT and the control groups. NRT, neonatal resuscitation training.
Figure 5
Figure 5
Forest plot comparing perinatal mortality between the NRT and the control groups. NRT, neonatal resuscitation training.
Figure 6
Figure 6
Forest plot comparing all SB between the post-NRT and the pre-NRT groups. NRT, neonatal resuscitation training; SB, stillbirths.
Figure 7
Figure 7
Forest plot comparing fresh SB between the post-NRT and the pre-NRT groups. NRT, neonatal resuscitation training; SB, stillbirths.
Figure 8
Figure 8
Forest plot comparing 1-day neonatal mortality between the post-NRT and the pre-NRT groups. NRT, neonatal resuscitation training.
Figure 9
Figure 9
Forest plot comparing 7-day neonatal mortality between the post-NRT and the pre-NRT groups. NRT, neonatal resuscitation training.
Figure 10
Figure 10
Forest plot comparing 28-day neonatal mortality between the post-NRT and the pre-NRT groups. NRT, neonatal resuscitation training.
Figure 11
Figure 11
Forest plot comparing perinatal m between the post-NRT and the pre-NRT groups. NRT, neonatal resuscitation training.
Figure 12
Figure 12
Funnel plot of comparison: Post-NRT verses pPre-NRT for all SB. NRT, neonatal resuscitation training; RR, risk ratio; SB, stillbirths.
See this image and copyright information in PMC

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