{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T21:28:17Z","timestamp":1793914097423,"version":"4.8.0"},"reference-count":38,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T00:00:00Z","timestamp":1667174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: In low- and middle-income countries, the leading cause of neonatal mortality is perinatal asphyxia. Training in neonatal resuscitation has been shown to decrease this cause of mortality. The program \u201cHelping Babies Breathe\u201d (HBB) is a program to teach basic neonatal resuscitation focused on countries and areas with limited economic resources. The aim of the study was to determine the effect of the implementation of the HBB program on newborn outcomes: mortality and morbidity. Material and Methods: A systematic review was carried out on observational studies and clinical trials that reported the effect of the implementation in low- and middle-income countries of the HBB program on neonatal mortality and morbidity. We carried out a meta-analysis of the extracted data. Random-effect models were used to evaluate heterogeneity, using the Cochrane Q and I2 tests, and stratified analyses were performed by age and type of outcome to determine the sources of heterogeneity. Results: Eleven studies were identified. The implementation of the program includes educational strategies focused on the training of doctors, nurses, midwives, and students of health professions. The poled results showed a decrease in overall mortality (OR 0.67; 95% CI 0.57, 0.80), intrapartum stillbirth mortality (OR 0.62; 95% CI 0.51, 0.75), and first-day mortality (OR 0.70; 95% IC 0.64, 0.77). High heterogeneity was found, which was partly explained by differences in the gestational age of the participants. Conclusions: The implementation of the program HBB in low- and medium-income countries has a significant impact on reducing early neonatal mortality.<\/jats:p>","DOI":"10.3390\/medicina58111567","type":"journal-article","created":{"date-parts":[[2022,11,1]],"date-time":"2022-11-01T06:01:28Z","timestamp":1667282488000},"page":"1567","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Effect of the Helping Babies Breathe Program on Newborn Outcomes: Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9154-4529","authenticated-orcid":false,"given":"Sergio","family":"Agudelo-P\u00e9rez","sequence":"first","affiliation":[{"name":"School of Medicine, Universidad de La Sabana, Campus Puente del Com\u00fan, Km. 7, Autopista Norte de Bogot\u00e1, Ch\u00eda 250001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Cifuentes-Serrano","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad de La Sabana, Campus Puente del Com\u00fan, Km. 7, Autopista Norte de Bogot\u00e1, Ch\u00eda 250001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"\u00c1vila-Celis","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad de La Sabana, Campus Puente del Com\u00fan, Km. 7, Autopista Norte de Bogot\u00e1, Ch\u00eda 250001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Oliveros","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad de La Sabana, Campus Puente del Com\u00fan, Km. 7, Autopista Norte de Bogot\u00e1, Ch\u00eda 250001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,31]]},"reference":[{"key":"ref_1","unstructured":"(2022, September 18). Objetivos y Metas de Desarrollo Sostenible\u2014Desarrollo Sostenible. n.d. Available online: https:\/\/www.un.org\/sustainabledevelopment\/es\/objetivos-de-desarrollo-sostenible\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1016\/S0140-6736(05)71088-6","article-title":"Evidence-based, cost-effective interventions: How many newborn babies can we save?","volume":"365","author":"Darmstadt","year":"2005","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Oestergaard, M.Z., Inoue, M., Yoshida, S., Mahanani, W.R., Gore, F.M., Cousens, S., Lawn, J.E., Mathers, C.D., and on behalf of the United Nations Inter-agency Group for Child Mortality Estimation and the Child Health Epidemiology Reference Group (2011). Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities. PLoS Med., 8.","DOI":"10.1371\/journal.pmed.1001080"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0140-6736(14)60496-7","article-title":"Every Newborn: Progress, priorities, and potential beyond survival","volume":"384","author":"Lawn","year":"2014","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3027","DOI":"10.1016\/S0140-6736(16)31593-8","article-title":"Global, regional, and national causes of under-5 mortality in 2000\u201315: An updated systematic analysis with implications for the Sustainable Development Goals","volume":"388","author":"Liu","year":"2016","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1936","DOI":"10.1016\/S0140-6736(08)60835-1","article-title":"Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: A cluster-randomised controlled trial","volume":"371","author":"Baqui","year":"2008","journal-title":"Lancet"},{"key":"ref_7","first-page":"CD007071","article-title":"In-service training for health professionals to improve care of the seriously ill newborn or child in low and middle-income countries (Review)","volume":"14","author":"Opiyo","year":"2010","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.clp.2016.05.001","article-title":"Global Burden, Epidemiologic Trends, and Prevention of Intrapartum-Related Deaths in Low-Resource Settings","volume":"43","author":"Ariff","year":"2016","journal-title":"Clin. Perinatol."},{"key":"ref_9","unstructured":"Narayanan, I., Rose, M., Cordero, D., Faillace, S., and Sanghvi, T. (2004). The Components of Essential Newborn Care, Basics Support for Institutionalizing Child Survival Project for the United States Agency for International Development."},{"key":"ref_10","unstructured":"World Health Organization (2012). Guidelines on Basic Newborn Resuscitation, World Health Organization."},{"key":"ref_11","first-page":"6","article-title":"An introduction to Helping Babies Breathe: The \"Golden Minute\" is here for South African newborn babies","volume":"16","year":"2012","journal-title":"Prof. Nurs. Today"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1111\/1552-6909.12019","article-title":"Helping Babies Breathe Around the World","volume":"42","author":"Steele","year":"2013","journal-title":"J. Obstet. Gynecol. Neonatal Nurs."},{"key":"ref_13","unstructured":"(2022, September 18). Helping Babies Survive. n.d. Available online: https:\/\/www.aap.org\/en\/aap-global\/helping-babies-survive\/."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.jpeds.2012.09.052","article-title":"Randomized Trial of Early Developmental Intervention on Outcomes in Children after Birth Asphyxia in Developing Countries","volume":"162","author":"Carlo","year":"2013","journal-title":"J. Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.earlhumdev.2014.04.013","article-title":"Developmental trajectories of children with birth asphyxia through 36months of age in low\/low\u2013middle income countries","volume":"90","author":"Wallander","year":"2014","journal-title":"Early Hum. Dev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1016\/j.ijgo.2009.07.013","article-title":"Neonatal resuscitation in low-resource settings: What, who, and how to overcome challenges to scale up?","volume":"107","author":"Wall","year":"2009","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Chaudhury, S., Arlington, L., Brenan, S., Kairuki, A.K., Meda, A.R., Isangula, K.G., Mponzi, V., Bishanga, D., Thomas, E., and Msemo, G. (2016). Cost analysis of large-scale implementation of the \u2019Helping Babies Breathe\u2019 newborn resuscitation-training program in Tanzania. BMC Health Serv. Res., 16.","DOI":"10.1186\/s12913-016-1924-2"},{"key":"ref_18","first-page":"i4919","article-title":"Risk of bias in non-randomized studies of interventions (ROBINS-I): Detailed guidance","volume":"355","author":"Loke","year":"2016","journal-title":"Br. Med. J."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Kc, A., Ewald, U., Basnet, O., Gurung, A., Pyakuryal, S.N., Jha, B.K., Bergstr\u00f6m, A., Eriksson, L., Paudel, P., and Karki, S. (2019). Effect of a scaled-up neonatal resuscitation quality improvement package on intrapartum-related mortality in Nepal: A stepped-wedge cluster randomized controlled trial. PLoS Med., 16.","DOI":"10.1371\/journal.pmed.1002900"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1111\/apa.13940","article-title":"Using quality improvement to decrease birth asphyxia rates after \u2018Helping Babies Breathe\u2019 training in Kenya","volume":"106","author":"Rule","year":"2017","journal-title":"Acta Paediatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e353","DOI":"10.1542\/peds.2012-1795","article-title":"Newborn Mortality and Fresh Stillbirth Rates in Tanzania After Helping Babies Breathe Training","volume":"131","author":"Msemo","year":"2013","journal-title":"Pediatrics"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.resuscitation.2015.04.019","article-title":"Frequent brief on-site simulation training and reduction in 24-h neonatal mortality\u2014An educational intervention study","volume":"93","author":"Mduma","year":"2015","journal-title":"Resuscitation"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Patel, A., Bang, A., Kurhe, K., Bhargav, S., Prakash, A., Arramraj, S., and Hibberd, P.L. (2019). Comparison of perinatal outcomes in facilities before and after Global Network\u2019s Helping Babies Breathe Implementation Study in Nagpur, India. BMC Pregnancy Childbirth, 19.","DOI":"10.1186\/s12884-019-2480-7"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1093\/tropej\/fmz072","article-title":"Reduction in Perinatal Mortality after Implementation of HBB Training at a District Hospital in Mali","volume":"66","author":"Innerdal","year":"2020","journal-title":"J. Trop. Pediatr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e20150117","DOI":"10.1542\/peds.2015-0117","article-title":"Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe","volume":"137","author":"Kc","year":"2016","journal-title":"Pediatrics"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Bellad, R.M., Bang, A., Carlo, W.A., McClure, E., Meleth, S., Goco, N., Goudar, S., Derman, R., Hibberd, P.L., and Petal, A. (2016). A pre-post study of a multi-country scale up of resuscitation training of facility birth attendants: Does Helping Babies Breathe training save lives?. BMC Pregnancy Childbirth, 16.","DOI":"10.1186\/s12884-016-0997-6"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1111\/apa.13835","article-title":"Improved postnatal care is needed to maintain gains in neonatal survival after the implementation of the Helping Babies Breathe initiative","volume":"106","author":"Wrammert","year":"2017","journal-title":"Acta Paediatr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e344","DOI":"10.1542\/peds.2012-2112","article-title":"Stillbirth and Newborn Mortality in India After Helping Babies Breathe Training","volume":"131","author":"Goudar","year":"2013","journal-title":"Pediatrics"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1136\/archdischild-2017-312809","article-title":"Perinatal outcomes following Helping Babies Breathe training and regular peer\u2013peer skills practice among village midwives in Sudan","volume":"103","author":"Arabi","year":"2018","journal-title":"Arch. Dis. Child."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e20193938","DOI":"10.1542\/peds.2019-3938","article-title":"Implementation of the Helping Babies Breathe Training Program: A Systematic Review","volume":"146","author":"Morris","year":"2020","journal-title":"Pediatrics"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1136\/archdischild-2018-316319","article-title":"Helping Babies Breathe and its effects on intrapartum-related stillbirths and neonatal mortality in low-resource settings: A systematic review","volume":"105","author":"Versantvoort","year":"2020","journal-title":"Arch. Dis. Child."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1159\/000460512","article-title":"How to Save 1 Million Lives in a Year in Low- and Middle-Income Countries","volume":"111","author":"Travers","year":"2017","journal-title":"Neonatology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"402","DOI":"10.9745\/GHSP-D-18-00291","article-title":"Helping Babies Breathe\u2014Beyond Training","volume":"6","author":"Hodgins","year":"2018","journal-title":"Glob. Health Sci. Pract."},{"key":"ref_34","first-page":"CD009106","article-title":"Standardised formal resuscitation training programmes for reducing mortality and morbidity in newborn infants","volume":"2015","author":"Dempsey","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"701","DOI":"10.11124\/JBISRIR-2017-003535","article-title":"The impact of the Helping Babies Survive program on neonatal outcomes and health provider skills: A systematic review","volume":"16","author":"Dol","year":"2018","journal-title":"JBI Database Syst. Rev. Implement. Rep."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1111\/apa.14706","article-title":"Does the Helping Babies Breathe Programme impact on neonatal resuscitation care practices? Results from systematic review and meta-analysis","volume":"108","author":"Budhathoki","year":"2019","journal-title":"Acta Paediatr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"S524","DOI":"10.1161\/CIR.0000000000000902","article-title":"Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"142","author":"Aziz","year":"2020","journal-title":"Circulation"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1111\/apa.13999","article-title":"Global gains after Helping Babies Breathe","volume":"106","author":"Niermeyer","year":"2017","journal-title":"Acta Paediatr."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/11\/1567\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:06:52Z","timestamp":1760144812000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/11\/1567"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,31]]},"references-count":38,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["medicina58111567"],"URL":"https:\/\/doi.org\/10.3390\/medicina58111567","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,31]]}}}