A systematic review of mortality and severe morbidities following newborn chest compressions at birth.

Abstract

To synthesise evidence for severe short-term outcomes following delivery room (DR) chest compressions (CC) and variation by birth setting, gestation, and level of care. Five databases and grey literature were systematically searched to 8 September 2025, for studies reporting mortality or severe morbidity after DR-CC (CRD42024487027). Study selection followed a population-exposure-outcome framework, and risk of bias was assessed using the JBI checklist. The primary outcome was mortality. Twenty-six studies (9,747 CC recipients, 1989-2019) from 16 high-income countries were included. DR-CC definitions varied (unspecified duration, ≥30-60 s, or plus epinephrine), with heart rate trigger rarely reported. Mortality ranged from 21% among moderate and late preterm infants to 27-74% among very preterm or very low birth weight infants, while severe neurological injury (NI) ranged between 16% and 42%. Studies with definitions that also required epinephrine reported higher mortality (39-74%) and severe NI (19-42%). Most studies did not distinguish DR deaths from subsequent in-hospital mortality. Evidence from low- and middle-income countries and for late preterm, term, and outborn infants, by care level, and by CC timeliness was sparse. The substantial variation in CC outcome estimates cannot be reliably ascribed to temporal or geographic factors, given the heterogeneity in inclusion criteria. Persistent gaps in differentiating DR deaths and stratifying outcomes by gestation, birth setting, care level, and CC timeliness underscore the need for prospective studies aligned with the Neonatal Utstein to improve precision and comparison of evidence in neonatal resuscitation.