Integrated neonatal resuscitation package linked to fewer adverse outcomes in Ethiopia

An integrated neonatal resuscitation package tested in public health facilities in Debre Birhan, Ethiopia, was associated with an 18.7 percentage-point lower probability of adverse composite neonatal outcomes among asphyxiated newborns, according to a non-randomized controlled quasi-experimental study published in BMC Pediatrics. The average treatment effect was −18.7 (p = 0.011; 95% CI [−30.9, −6.5]) after adjustment for maternal demographics, clinical conditions at admission, and delivery-specific variables.

The study, conducted from March 1, 2024, to January 30, 2026, enrolled a total of 1,260 asphyxiated babies. After accounting for six participants lost to follow-up, the final analysis included 1,254 newborns. Baseline assessments were carried out in both control and intervention sites, and baseline comparability was assessed using chi-square or Fisher’s exact tests and independent t-tests.

The intervention targeted a well-documented gap in neonatal care. Each year, an estimated 900,000 neonatal deaths worldwide are attributed to intrapartum hypoxic events, or birth asphyxia, and survivors often suffer neurological impairments, with disproportionately high rates in Sub-Saharan Africa, including Ethiopia. Effective neonatal resuscitation reduces this risk, but its impact is limited by delayed or interrupted ventilation, prompting the researchers to evaluate strategies promoting early and continuous ventilation.

Providers in the control group received standard neonatal resuscitation simulation training, while those in the intervention group received the same training enhanced with an integrated device featuring a real-time feedback system. Data were collected via Kobo Toolbox and analyzed using Stata 17, with a Difference-in-Differences (DID) analysis used to evaluate the intervention’s effect on composite adverse neonatal outcomes.

The authors report that the integrated package was associated with a lower probability of adverse neonatal outcomes. However, they caution that because of the non-randomized design, the small number of facilities, and the bundled nature of the intervention, causal inference is limited and the effect of individual components cannot be determined. The study was registered in the Pan African Clinical Trial Registry (PACTR202605670069858) on 04 May 2026, retrospectively, and the article was published open access on 29 October 2026.

Given these limitations, the researchers call for larger, preferably cluster-randomized, studies and economic evaluations before any scale-up of the package.

Subject of Research: Neonatal resuscitation and birth asphyxia outcomes in Ethiopian public health facilities

Article Title: Effect of an integrated neonatal resuscitation package on adverse neonatal outcomes in public health facilities, Ethiopia: a non-randomized quasi-experimental study

Article References: Moltot, T., Kebede, T. N., Chekole, M. S., Demissie, L., Taye, B. T., & Lindgren, H. (2026). Effect of an integrated neonatal resuscitation package on adverse neonatal outcomes in public health facilities, Ethiopia: a non-randomized quasi-experimental study. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07962-5

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07962-5

Keywords: neonatal resuscitation, birth asphyxia, Ethiopia, quasi-experimental study, NeoBeat, bag-mask ventilation, PEEP, neonatal outcomes, Difference-in-Differences, public health facilities, Effect, integrated