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Table 6 Effect of training in neonatal resuscitation for physicians and other health workers on stillbirths and perinatal mortality

From: Delivering interventions to reduce the global burden of stillbirths: improving service supply and community demand


Location and Type of Study


Stillbirths/Perinatal Outcomes

Intervention studies

Cowles 2007 [89]

Northern India. Rural hospitals.

An intervention study.

Assessed the impact of the Basic Neonatal Resuscitation Program (BNRP) for the birth attendants (nurses and ward aides) in providing more effective neonatal resuscitation at birth.

SBR: decreased in the hospitals where the course had been taught on site.

Doctors stated that, when called for resuscitation, they would find the nurses giving the Ambu Bag, and a living baby, when before the babies had died.

Deorari et al. 2001 [90]

India. 14 teaching hospitals.

Before-after study. N = 28 faculty members from each hospital, who in turn trained staff at their own hospital. Each institution provided 3 months pre-intervention and 12 months post-intervention data.

Compared the impact for 12 months after (intervention) vs. for 3 months before (control) use of Neonatal Resuscitation Programme (NRP) in teaching hospitals to doctors and nurses.

Total cause-specific NMR: 901/25,713 (3.5%) vs. 264/7,070 (3.7%) after and before the intervention, respectively. (P > 0.05).

Asphyxia-related cause-specific mortality: Significant reduction (P < 0.01).

Jeffery et al. 2004 [164]

Macedonia. 16 participating hospitals.

National perinatal strategy programme.

Assessed the impact of a train-the-teachers education intervention to develop the capacity of health professionals to introduce evidence-based perinatal practice originally developed in Australia.

PMR: RR = 0.79 (95% CI: 0.73–0.85).

[21.5/1000 vs. 27.4/1000 after vs. before, respectively].

Early NMR: 36% reduction (infants > 1000 g birth weight)

A total of 115 doctors and nurses graduated from this programme.

Kumar et al. 1994, 1995 [98, 97]

India. Rural setting.

Prospective cohort study. N = 58 cases of asphyxia; 38 delivered by conventionally trained TBAs [N = 968] and 20 by TBAs with advanced training [N = 911].

Simplified methods of resuscitation were taught to TBAs. An additional group received advanced training on use of the mucous extractor and bag-and-mask ventilation.

PMR: 19% reduction comparing advanced vs. conventionally trained TBAs, respectively.

Asphyxia-associated perinatal mortality: 70% reduction comparing advanced vs. conventionally trained TBAs, respectively.

Raina et al. 1989 [96]

India (Haryana). Villages of Ambala District.

Exploratory study. TBAs (N = 100) where 90% of deliveries occur at home, and are performed by TBAs.

To assess the training needs of traditional birth attendants with reference to their knowledge of the causes of birth asphyxia, their capacity to recognise it and the methods they were using to manage the condition.

TBAs mentioned 6 resuscitation measures they used in birth asphyxia. 4 or more of these were only used by 20 of the TBAs. 70% of the participants used resuscitation procedures for 1/2 hour before giving up due to such prognostic features as a blue or pale color, the absence of cord pulsations, no breathing, limpness and the absence of pulsations in the anterior fontanelle.

Knowledge of modern resuscitation equipment and procedures was poor and referrals were made based on the proximity of the institution and not on the quality of care available.

Zhu et al. 1997 [91]

China (Zhuhai). Maternal and Child Health Hospital.

Perspective, before-and-after intervention study. N = 4,751 newborns with 366 asphyxiated babies in a period of 2 years and historical controls of 1,722 live births.

Compared the impact on neonatal mortality of the Neonatal Resuscitation Program (NRPG) (intervention) vs. historical controls when the traditional resuscitation program was in place.

PMR: 3-fold decrease with NRPG compared to historical controls (chi(2) = 10.54, P < 0.01).

Observational studies

Blond et al. 1994 [93]

France. 31 maternity hospitals.

Before-after study. N = 156 medical personnel (doctors, mid-wives) and paramedics [53% of all available personnel].

To assess the impact of special training to medical personnel (intervention) vs. personnel without any special training (control) in 1990.

Improved neonatal resuscitation rates compared with untrained personnel.

Severe meconium aspirations: 0 vs. 3 in 1990 vs. 1989, respectively.