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Table 2 Observational studies of neonatal resuscitation training programs in facility settings with mortality outcomes

From: Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths: a systematic review, meta-analysis and Delphi estimation of mortality effect



Study Design

Intervention definition

Outcomes: definition

Distinguish Preterm from Intrapartum Deaths

N (Births) A = Baseline

B = Endline

Effect Size



Zhu XY et al 1997[3]

Urban Hospital China

Before-and-after study

AAP NRP training at of all delivery room staff at hospital

1) Early Neonatal Mortality (first 7 days): ALL cause

Not stated

A) 1,722;

B) 4,751

1) RR 0.34


Deorari AK et al 2001[2]

14 University Hospitals, India

Before-and-after study

AAP NRP training of 2 faculty/hospital, subsequent training of DR room nurses and doctors; competency based certification

1) Asphyxia neonatal mortality [Features of fetal hypoxia and 5 min Apgar <6 following complications of pregnancy or delivery];

2) Hypoxic Ischemic Encephalopathy;

3) Preterm mortality [BW < 1000 g with HMD, IVH or AOP]

Excluded BW < 1000 g, death from HMD/IVH or AOP

A) 7,070; B)25,713

1) RR 0.70


2) RR 1.68


3) RR 0.95


Vakrilova L et al 2005[44]

All hospitals with delivery rooms in Bulgaria

Before-and-after study

French-Bulgarian Program on Newborn Resuscitation, training in all obstetric wards in country

1) Asphyxia Neonatal Mortality [ICD 9 'perinatal and intrapartum asphyxia'],

2) Early neonatal mortality (first 7 days)

3) Preterm complication [ICD-9 'immaturity related' and 'respiratory distress syndrome']

Excluded death due to preterm complications by ICD-9

A) 67,948;

B) 67,647

1) RR 0.83


2) RR 0.86


3) RR 1.33 (1.03-1.73)

Carlo, et all 2010 [38]/Chomba E et al 2008[39]

18 Urban Low-risk delivery centers, Zambia

Before-and-after study,then RCT

WHO ENC Package, including basic resuscitation with bag-mask,taught by demonstration, clinical practice sessions, and performance evaluations; followed by longer in depth training in NRP including bag-mask ventilation and chest compressions

1) Asphyxia Early Neonatal Mortality (7 d), [not breathing at birth];

2) Early Neonatal Mortality [first 7 days];

3) Preterm Mortality [preterm or BW <1500]

Preterm or LBW (< 1500 g) as separate cause of death, though no hierarchy specified for single cause of death

A) 8,148;

B) 20,534

1) RR 0.56 (NS)

2) RR 0.60 (0.48-0.76)

3) RR 0.74 (NS)