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Helping Babies Breathe and its effects on intrapartum-related stillbirths and neonatal mortality in low-resource settings: a systematic review
  1. Jorien M D Versantvoort1,
  2. Mirjam Y Kleinhout2,
  3. Henrietta D L Ockhuijsen1,3,
  4. Kitty Bloemenkamp4,
  5. Willem B de Vries2,
  6. Agnes van den Hoogen1,2
  1. 1 Clinical Health Science, Utrecht University, Utrecht, The Netherlands
  2. 2 Department of Neonatology, Birth Center Wilhelmina’s Children Hospital, Division Women and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3 Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
  4. 4 Department of Obstetrics Birth Center Wilhelmina’s Children Hospital, Division Women and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Agnes van den Hoogen, Intensive Care Neonatology, Wilhelmina’s Children’s Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht 3508 AB, The Netherlands; ahoogen{at}


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

  • neonatal mortality
  • helping babies breathe
  • resuscitation
  • low income countries
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  • JMDV and MYK contributed equally.

  • Contributors JMDV conceptualised and designed the study, collected data, performed the data search, carried out the analyses and drafted the manuscript. MYK conceptualised the study, performed the second data search and collection, carried out data analysis and designed the manuscript. These both authors contributed equally. KB critically reviewed and revised the manuscript for important intellectual content. WBdV critically reviewed the manuscript and considerably contributed to the editing and revision of this systematic review. HDLO critically reviewed and revised the manuscript on methodological quality and design. AvdH conceptualised and designed the study, coordinated and reviewed the data collection and instruments, reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice The article type has been changed to Original article since this paper was published Online First.

  • Patient consent for publication Not required.

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