The NLS (Neonatal Life Support) course has been delivered nationally in an evolving manner for 14 years.1 It provides consistent, high-quality training in neonatal resuscitation, particularly non-invasive airway support in a one day setting, using the best currently available evidence. Recertification to maintain ‘provider’ status is required every 4 years, in line with other life support courses. Candidates come from across the spectrum of disciplines and settings in which the sick newborn may need attention.

Newborn infants are generally well, so the majority of the skills taught, beyond drying and wrapping are probably rarely used. The literature suggests that only 0.4–1% of infants over 2.5 kg or 37 weeks’ gestation need airway support and/or lung inflation.1 It is therefore likely that many candidates, particularly those in smaller centres or lower-risk settings do not use their skills frequently. Even in larger perinatal centres full cardiopulmonary resuscitation is uncommon. Once working patterns are accounted for an individual will only rarely participate in a resuscitation requiring all the airway, breathing and cardiac skills taught during the NLS course.

Mosley et al 2 report on what happens to the skills acquired on the NLS course. They found, upon reassessing at 3–5 months and again at 12–14 months, that the skills of candidates had deteriorated, particularly …