Improving team performance in neonatal resuscitation: a systematic review of training programs

Neonatal resuscitation is time-sensitive and critical for reducing neonatal mortality. While training programs improve technical skills, their clinical impact is limited by poor retention and inconsistent emphasis on team-based competency. Given the high-pressure and collaborative nature of resuscitation, strong communication, coordination, and teamwork are essential. There is a growing need to integrate structured teamwork training into neonatal resuscitation training programs to strengthen team cohesion, reduce errors, and improve neonatal outcomes. A systematic review was conducted to synthesise evidence on how neonatal resuscitation training programs can be designed to improve team performance. The review question was formulated using the PIOS framework, and an adapted five-step systematic review approach was followed to conduct the review. A comprehensive search of 11 databases and supplementary sources identified 1,871 records, of which 19 met the inclusion criteria and scored ≥ 75% on the Johns Hopkins Evidence Critical Appraisal Tool. Data were extracted and thematically analysed by two independent reviewers. Two overarching themes emerged: (1) teamwork skills and behaviours, namely leadership, communication, joint decision-making, clearly defined roles and responsibilities, and safe practice; and (2) strategies for teaching teamwork, namely simulation, debriefing, and multidisciplinary team training. Most studies have been conducted in high-resource environments, with only a few conducted in resource-restricted healthcare contexts. Effective team performance is critical for successful neonatal resuscitation. Training programs should integrate teamwork skills, behaviours, and structured team-based teaching strategies to improve team performance. Future research should focus on developing adaptable and resource-sensitive training models that incorporate these elements to enhance neonatal outcomes on a global scale.