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Table 4 GRADE assessment of studies of the effect of Neonatal Resuscitation training in facilities on neonatal mortality from Intrapartum-related events (ie. “birth asphyxia”)

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

No of studies Design Limitations Consistency Generalizability to Population of Interest Generalizability of intervention of interest Post-InterventionEvents Control- Baseline Events Relative Risk (95% CI)
Mortality ( Intrapartum-related Neonatal Deaths ) : Moderate outcome specific mortality
3 [2, 38, 44] Before-and-after Low quality No evidence of heterogeneity (P=0.5) Facility settings (ranging primary to tertiary care level), LIC-MIC Advanced NRP in 2 studies, WHO Basic ENC in another 360* 185 0.70 (0.59, 0.84)a
Mortality ( Early Neonatal Deaths ) : Moderate outcome specific mortality
3 [3, 38, 44] Before-and-after Low quality Strong evidence of heterogenity (P=0.002) Facility settings (ranging primary to tertiary care level), LIC-MIC Advanced NRP in 2 studies, WHO Basic ENC in another 454* 458 0.62 (0.41, 0.94)b
Morbidity ( Hypoxic Ischemic Encephalopathy ) : Low outcome specific morbidity
1 [2] Before-and-after Low quality NA Only 1 study, tertiary care hospital Advanced NRP 128* 21 1.68 (1.06, 2.66)c
  1. a) MH pooled RR; b) D & L pooled RR random effect meta-analysis; c) Directly calculated from study results
  2. * Note numbers of events in post-intervention period are based on longer duration of observation period than baseline