Assessment tools for neonatal resuscitation and their validity evidence: a scoping review

• Tools vary in content, structure, and intended use. • All tools assess multiple competencies, but none covers all resuscitation skills. • Most tools lack proper validity evidence. • Contemporary validity frameworks are preferred, but rarely used. • An up-to-date, validated tool is needed, applicable across multiple settings. Competence in neonatal resuscitation is acquired and maintained through accredited life support courses and short in-situ booster training sessions.​​ To ensure effective knowledge and skills integration into practice, valid tools for assessing performance are essential. The aim of this scoping review was to identify all available tools assessing overall performance neonatal resuscitation and evaluate their reported validity evidence. In January 2024 and July 2025, MEDLINE, Embase, and the Cochrane Library were searched to identify studies describing assessment tools for neonatal resuscitation and their associated validity evidence. All study types describing neonatal resuscitation assessment tools for simulation and clinical practice were included. Two reviewers independently screened titles and abstract followed by full-text screening. Data were extracted using predefined forms. A total of 146 sources were included, identifying 82 unique assessment tools for neonatal resuscitation. The number of included items in these tools varied widely, ranging from 5 to 133 (median= 22, IQR= 15-36). Some form of validity evidence was reported for 73.2% of these tools. Most studies reported items from classical frameworks for validity evidence; however, only 30.0% reported more than two items of these frameworks. Contemporary frameworks for validity evidence, considered the preferred standard, were only (partly) applied in three studies. Multiple assessment tools for neonatal resuscitation have been reported, most lack proper validity evidence. There is a clear need for further research and development of a comprehensive, up-to-date, properly validated, and widely applicable assessment tool to support high-quality training, reliable assessment, and ultimately improve patient outcomes.