Table 7 Cause specific mortality effects and GRADE estimate for the effect of newborn resuscitation

Effect on intrapartum-related neonatal deaths (“birth asphyxia”)

Cause specific effect

Immediate newborn assessment, drying, and stimulation 10% (Range 0-25%, IQR 5-15%)

Basic neonatal resuscitation (facility) 30% (95% CI: 16 - 41%)

Basic neonatal resuscitation (community) 20 % (Range 10-50%, IQR 15-25%)

(*note that the resuscitation effect is in addition to immediate assessment, drying, and stimulation)

Quality of input evidence:

Basic neonatal resuscitation (facility) - moderate (3 low quality before-and-after studies, upgraded for consistency)

Immediate newborn assessment, drying, and stimulation - very low (based on Delphi)

Basic neonatal resuscitation (community) - very low (based on Delphi)

Proximity of the data to cause specific mortality effect:

Moderate (cause specific mortality but lack of consistency in cause-of-death definitions)

Limitations of the evidence:

There is a lack of rigorous evaluation particularly for the effect of immediate newborn assessment, drying, and stimulation. Data are compromised by misclassification of live births and intrapartum stillbirths and by inconsistencies in cause-of-death attribution between term intrapartum-related neonatal deaths and preterm complications especially if a clinical case definition of “not breathing at birth” (“birth asphyxia”) is applied which includes both categories.

Possible adverse effects:

Babies who survive despite severe brain injury may have long term impairments. There is a dearth of data on long term outcomes from low and middle income settings.