John: Around the world, approximately four million babies die every year before they are one month old, with almost half of these deaths occurring on the first day. In September 2015, a new Cochrane Review brought together the evidence on the potential benefits of standardised formal neonatal resuscitation training programs. One of the authors, Mohan Pammi from Baylor College of Medicine in Houston, USA outlines the findings in this evidence pod.

Mohan: Almost all of the four million neonatal deaths each year occur in middle and low income countries, with asphyxia causing approximately one quarter of these deaths. We also know that approximately 10% of newborns require some assistance at birth and up to 1% require extensive resuscitation. Therefore, having adequately trained personnel available for resuscitation during delivery may decrease neonatal mortality and morbidity. Neonatal resuscitation education seeks to translate the science of resuscitation into practice through a training program. Substantial healthcare resources are expended on standardised formal neonatal resuscitation training programs, or SFNRT for short. We wanted to see how effective they are and have found some promising results.
Our primary aim was to determine the effectiveness of SFNRT programs in reducing neonatal mortality and morbidity in the newborn infant. We also wanted to see if SFNRT changed the behavior of healthcare providers, and their acquisition and retention of knowledge and skills.
We followed the standard methods of the Cochrane Neonatal Review Group and did our most recent searches for studies in April 2015. We were looking for randomised, quasi-randomised or cluster randomised trials that had compared a SFNRT with either no SFNRT, additions to SFNRT or another type of SFNRT. But in this podcast, I’ll focus on the results of studies comparing SNFRT with no SFNRT or those with only basic newborn care.
We found three community-based cluster-randomised trials in developing countries that had compared SFNRT with basic newborn care. These provide moderate quality evidence that SFNRT decreased early neonatal mortality which mortality in the first 7 days of life and low quality evidence from one trial showed that SFNRT may decrease 28-day mortality, although the effect on late neonatal mortality was more uncertain.
We also identified two community-based and three manikin-based trials that assessed the effects of SFNRT compared with no SFNRT. There was very low quality evidence from a single study that suggested improvement in acquisition of knowledge and skills and in retention of knowledge, and another study suggested improvement in resuscitation and behavioural scores.
In summary, our review allows us to conclude that standardised formal neonatal resuscitation training compared to basic newborn care results in a reduction of early neonatal and 28-day mortality in developing countries. However, several questions remain to be answered and future randomised trials of SFNRT should report on neonatal morbidity including hypoxic ischaemic encephalopathy and neurodevelopmental outcomes; while innovative educational methods that enhance knowledge and skills and teamwork behaviour should also be evaluated.

John: If you would like to read more about the trials that Mohan mentioned, and the other studies and comparisons they found for the Cochrane Review, you can find it easily in the Cochrane Library. Just go to Cochrane library dot com and search for 'SFNRT'.