Helping Babies Breathe and its effects on intrapartum-related stillbirths and neonatal mortality in low-resource settings: a systematic review

Abstract

Background: An important factor in worldwide neonatal mortality is the deficiency in neonatal resuscitation skills among trained professionals. 'Helping Babies Breathe' (HBB) is a simulation-based training course designed to train healthcare professionals in the initial steps of neonatal resuscitation in low-resource areas. The aim of this systematic review is to provide an overview of the available evidence regarding intrapartum-related stillbirths and neonatal mortality related to the HBB training and resuscitation method.

Data sources: Cochrane, CINAHL, Embase, PubMed and Scopus.

Study eligibility criteria: Conducted in low-resource settings focusing on the effects of HBB on intrapartum-related stillbirths and neonatal mortality.

Study appraisal: Included studies were reviewed independently by two researchers in terms of methodological quality.

Data extraction: Data were extracted by two independent reviewers and crosschecked by one additional reviewer.

Results: Seven studies were included in this systematic review; the selected studies included a total of 230.797 neonates. Significant decreases were found after the implementation of HBB in one of two studies describing perinatal mortality (n=25 108, rate ratio (RR) 0.75; p<0.001), four out of six studies related to intrapartum-related stillbirths (n=125.720, RR 0.31-0.76), in four out of five studies focusing on 1 day neonatal mortality (n=111.289, RR 0.37-0.67), and one out of three studies regarding 7 day neonatal mortality (n=4.390, RR 0.32). No changes were seen in late neonatal mortality after HBB training and resuscitation method.

Limitations: Included studies in were predominantly of moderate quality, therefore no strong recommendations can be made.

Conclusions and implications of key findings: Due to the heterogeneous quality of the studies, this systematic review showed moderate evidence for a decrease in intrapartum-related stillbirth and 1-day neonatal mortality rate after implementing the 'Helping Babies Breathe' training and resuscitation method. Further research is required to address the effects of simulation-based team training on morbidity and mortality beyond the initial neonatal period.

Prospero registration number: CRD42018081141.

Keywords: helping babies breathe; low income countries; neonatal mortality; resuscitation.