Table 2.

Evaluation of included studies.

Study	Study details	Participants	Interventions	Comparisons	Outcomes
Skåre6	Prospective, pre/post interventional study. Initial phase of a multi-faceted quality improvement initiative.	Midwives and physicians involved in resuscitation of compromised infants at a Norwegian teaching hospital in 2014.	Introduction of weekly video assisted debriefing (3rd April–23rd June 2014)	NRPE scores in the pre, peri and post intervention period.	Pre vs post implementation
	Skill performance and process of care evaluation before, during and after introducing video debriefing of resuscitation events.	73 resuscitation events pre- implementation were compared to 45 events post- implementation	Followed by monthly video assisted debriefing in a post implementation period (24th June–24th August 2014)	Baseline evaluations were performed 15th January–2nd April 2014.	Total NRPE scores (77% vs 89%, p < 0.001)
	Evaluation used a modified Neonatal Resuscitation Evaluation Performance (NRPE) tool.				Improved preparation & adherence to the initial steps of a neonatal resuscitation algorithm (75% vs 90%, p < 0.001)
	NRPE scores by single investigator but intra-rater reliability and inter-rater reliability checked by a 2nd investigator.				Improved PPV (70% vs 100%, p < 0.001)
					Improved group function, communication–88% vs 100%, p < 0.001)
Sauer8	Single centre pre-post quality improvement initiative.	High risk delivery team	Described as a bundle of delivery room interventions. Individual interventions are not clearly described.	Pre vs post intervention: Data for 249 infants prior to the intervention were compared to data for 299 born after the intervention.	Functioning pulse oximeter by 2 min (26% to 55%, p value unclear)
	Data on 548 infants representing every admission to the Palomar Rady Children’s Hospital NICU during a 35 month period (1st Jan 2010–30th November 2012).	(not further specified)	The delivery room checklist is shown in the paper and appears to be the main intervention.		% intubated (14% vs 5%, p < 0.001)
	It aimed to achieve:		Briefing/debriefing is included within the checklist.		Surfactant use (2.8 vs 1.0%, p = 0.198)
	● Placement of a functioning pulse oximeter by two minutes after birth				Normothermia on NICU admission (78% vs 86%, p = 0.017)
	● Delayed intubation in favour of CPAP use				% using checklist (25% to 92%, p < 0.001)
	● Normothermia at NICU admission				Outcome data collected for RDS, BPD, death, PDA, pneumothorax, NEC, ROP, post haemorrhagic hydrocephalus (PHH), IVH, length of stay. Univariable & multivariable logistic regression done. (MV regression not for BPD, death, ROP, PHH)
	● Use of a team briefing, debriefing and delivery room checklist to promote teamwork and communication between the obstetrician, labour and delivery room staff and the neonatal resuscitation team				No significant differences except for ↓ROP in univariable logistic regression for post intervention group (OR 0, 0.696; p = 0.008)
Katheria9	Pre/post study to evaluate the implementation of a checklist that included pre-brief and debrief components. Outcomes were measured at video resuscitation quality assurance (QA) meetings. The completed pre-brief checklist was reviewed prior to seeing each video to see if planned preparation happened. The completed debrief findings were reviewed after watching each video to see if team conclusions matched video review conclusions.	Neonatal faculty, neonatal fellows, pediatric residents in training, nurses, respiratory therapists.	Pre-brief:	First two years of using the delivery room checklist (March 2009–November 2011, 260 completed checklists) were compared with the 3rd year of using the delivery room checklist (185 completed checklists).	Most common problems:
	The components of the checklist were informed by crew resource management training previously undertaken by NICU staff and ongoing video reviews of neonatal resuscitations.		Introduction of team members, role assignments, specific considerations, team empowered to voice concerns and to call back orders.		Communication (n = 58)
			Equipment checklist with duty specific sub lists and required setup with the requirement to acknowledge completion.		Equipment preparation and use (n = 56)
			Debrief:		Inappropriate decisions (n = 87)
			Free form questions on what went well, what didn’t go well and what needed to be improved. Debrief completed soon after resuscitation with all team members involved. Members responded in order of seniority, most junior first.		Leadership (n = 56)
			QA review:		Procedures (n = 25)
			Completed checklists were reviewed with special emphasis on the debrief section at twice monthly video resuscitation quality assurance meetings		During the 3rd year of use (Nov 2011 to May 2012), 185 checklists were reviewed.
					Communication problems ↓ from 22% to 4% (p < 0.001). This finding was reported on the checklists and validated in audio & video recordings.
					Non-significant changes:
					● Lack of equipment preparation & use (21% vs 23%)
					● Inappropriate decisions (33% vs 27%)
					● Leadership (21% vs 18%)
					● Procedures-sequence, timing, technique (10% vs 6%)
Magee10	Prospective, randomised control study of Rapid Cycle Deliberate Practice (RCDP) vs. traditional simulation debriefing methods for neonatal resuscitation training.	38 pediatric interns in a large academic training programme.	Instructional simulation session with RCDP	Instructional simulation session with standard debriefing that occurred at the conclusion of the simulation scenario	34 interns included in the analysis. 4 were excluded due to changes in study protocol and technical issues.
	Study occurred over 1.5 years with 3−4 interns enrolled each month.	All the interns held a current NRP certification and were on a neonatology or newborn nursery rotation when enrolled.	Immediate simulation retest	Immediate simulation retest	RCDP group compared to simulation debriefing group:
	Randomisation occurred in blocks of 4 interns to account for variations in abilities in the first year of academic training.		.		Higher MCAF scores
	Pre-survey looking at confidence in neonatal resuscitation and previous experience completed.				(89% vs 84%, p < 0.026)
	Primary outcome was the interns’ score on the megacode assessment form (MCAF) on immediate testing.				Initiated PPV ventilation within 1 min (100% vs 71%, p < 0.05)
	Secondary outcomes measured at a 4-month follow-up were: confidence level in neonatal resuscitation, recall MCAF scores and time to perform critical interventions.				More consistently provided PPV for the appropriate duration of time before starting CC (17 s vs 12 s, p < 0.05)
					Administered epinephrine earlier (152 s vs 180 s, p = 0.039)
					Self-reported confidence levels increased in both groups but were not different between the two groups.
					MCAF scores and time to perform critical interventions at 4 months were not different between the two groups.