Published in PLOS One on 2026-01-08, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Kourtney R Bettinger, Daniel K Ishoso, Amy S Mackay, Carl L Bose, Patricia P Gomez, Ingunn A Haug, Helge Myklebust, Benjamin H Chi, Eric M Mafuta, Jackie K Patterson, Ju Ok Park, Kindu Wondie
Source: PLOS One • DOI 10.1371/journal.pone.0310606
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Basic resuscitation practices, particularly bag-mask ventilation, reduce newborn deaths from respiratory depression. There is strong scientific premise for improving bag-mask ventilation with feedback strategies, but there are significant barriers to bedside feedback in low-resource settings. To address these barriers, we developed LIVEBORN, a mobile health application to support feedback for newborn resuscitations. LIVEBORN uses data on provider actions and the newborn’s condition entered in real-time by an observer to provide real-time guidance during resuscitation and support debriefing after resuscitation. In a pilot study, we designed and then evaluated strategies to incorporate LIVEBORN Feedback into clinical practice at two health facilities in the Democratic Republic of the Congo, with one facility allocated to real-time guidance and one to debriefing. Providers at each facility used a participatory research methodology called Trials of Improved Practices to design and refine their strategy prior to pilot testing. The primary outcome of the pilot study was the feasibility of observing resuscitation care with LIVEBORN, defined as the percentage of births observed using LIVEBORN with a threshold of at least 50% of births observed to achieve feasibility. We also evaluated usability with the System Usability Scale and explored midwives’ perceptions of LIVEBORN Feedback in focus group discussions. During the pilot test, we found both strategies to be feasible with 74% of births observed with LIVEBORN at the real-time guidance facility and 67% at the debriefing facility. The strategy was also sufficiently usable with a System Usability Scale median score of 68 (Q1 65, Q3 78). Midwives perceived LIVEBORN Feedback to be helpful and believed it could save lives, but sometimes disagreed with LIVEBORN Feedback’s guidance to ventilate. In conclusion, we identified context-specific, feasible strategies for incorporating LIVEBORN Feedback into clinical care. We are now evaluating the effectiveness of LIVEBORN Feedback in a randomized control trial.
Introduction
One million newborns die on their day of birth each year, accounting for one third of all newborn deaths [1]. Ninety percent of these deaths are from intrapartum-related events resulting in failure to breathe at birth (i.e., respiratory depression) [2]. Over 90% of these deaths occur in low and lower-middle income countries (LMICs) [3].
Basic resuscitation practices reduce death from respiratory depression [4]. Among these practices, bag-mask ventilation (BMV) has the greatest impact on mortality. To be effective, BMV must be timely. Resuscitation algorithms recommend initiating BMV of non-breathing newborns within 60 seconds after birth [5,6]. Delayed BMV increases the risk of death: for example, for every 30-second delay in BMV in a cohort of newborns in Tanzania, the risk of death or prolonged hospital admission increased by 16% [7,8]. Effective BMV is also continuous, with ventilation recommended until spontaneous breathing begins.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider technology & industry desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Kourtney R Bettinger, Daniel K Ishoso, Amy S Mackay, Carl L Bose, Patricia P Gomez, Ingunn A Haug, Helge Myklebust, Benjamin H Chi, Eric M Mafuta, Jackie K Patterson, Ju Ok Park, Kindu Wondie. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Improving maternal outcomes of young mothers through mobile health (mHealth) and community-based interventions: Evidence from a quasi-experimental trial in Kwale County, Coastal Kenya
- Evidence brief: Feasibility and testing outcomes of task-shared implementation of advanced HIV disease point of care tests in Beira (Mozambique) and Kinshasa (DRC)
- Evidence brief: Healthcare providers’ awareness of a mobile-based app for disease classification in northwest Ethiopia: A multilevel logistic regression analysis
