Impact of the helping babies breathe program on neonatal mortality and morbidity : Systematic review and meta-analysis

Abstract

Introduction: In low and middle-income countries the leading cause of neonatal mortality are acute birth events and perinatal asphyxia, training in neonatal resuscitation has been shown to decrease these causes of mortality. The program "Helping Babies Breathe" is a basic neonatal resuscitation program, which aims to strengthening neonatal resuscitation with five simple steps to follow that effectively resuscitate infants: adequate respiratory support with a mask bag, thermoregulation, stimulation, evaluation and early initiation of breastfeeding, focused on the first minute of life in countries and areas with limited economic resources, We pretended to determine the impact of the implementation of this program on newborn mortality, through a systematic review and meta-analysis. Method: A systematic review and meta-analysis was performed. We included observational studies and clinical trials in electronic databases, that evaluated the impact of the implementation of the 'Helping Babies Breathe' program on neonatal mortality. Two independent reviewers conducted data extraction and the study quality assessment. A fixed-effect and random-effect models were used to evaluated heterogeneity, using Cochrane Q and I2 , and stratified analyses were performed by age and type of outcome, to determine the sources of heterogeneity. Results: Most of the included studies were carried out in countries with low and low middle economic resources, by means of an educational strategy of training health personnel and / or midwives who attend the binomial neonate-mother at birth. A decrease in overall mortality was observed with an OR 0.67 (95%CI 0.57 - 0.80) and in intrapartum mortality with an OR 0.62 (95%CI 0.51 - 0.75). A high heterogeneity was found which was partly explained by differences in the gestational age of the participants. Discussion and Conclusions: The implementation of the program "Helping Babies breathe", in countries with low and medium-low economic resources, have a significative impact on reducing neonatal mortality, especially in intrapartum mortality.