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

Background An important factor in worldwide neonatal mortality is the deficiency in neonatal resuscitation skills among trained professionals. a € 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 a € 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.