three months and the follow-up measurements were the sum of data from the final three months. A Paired T-Test was conducted to determine if beginning and follow-up values were significantly different. The number of deliveries and Caesarian sections were analyzed as potential confounding factors. The program coordinator collected data from standard hospital reports and hospital logs into monthly reports, with the program coordinator responsible for data quality checks and integrity. The monthly reports were forwarded to SSN and to US-based research assistants. SSN conducted an initial review, analysis, and prepared mandated reports. Research assistants combined the data into a master file, clarified missing variables with the coordinator, deleted variables missing significant data, changed text into appropriate numerical values, and conducted data analysis using Statwing, the statistical analysis software of Qualtrics, and Excel. Data registration and program administration The scale-up and retention improvement program and assessment, including data collection from the materials (flipcharts, booklets and electronic copies), training mannequins (NeoNatalies), and delivery room equipment (bag-and-mask, Penguin suction, stethoscope) to facilitate immediate clinical and teaching applications in the 18 facilities. Consistent with the goal of a low-cost training support program, a single experienced medical trainer with research experience was recruited to serve as the coordinator for the entire portfolio of facilities. As a full-time employee of SSN, the coordinator served as a trainer, mentor, administrative liaison, and monitor of health indicators. The program coordinator utilized evidence-based methods to build the capacity of facility-based trainers and staff. The coordinator was empowered to: • Scale-up HBB training to all relevant personnel, including new staff additions • Promote low-dose, high-frequency practice, including daily bag-and-mask skill checks • Provide refresher training • Encourage structured self-evaluation • Hold weekly or biweekly review meetings for peer review of the HBB protocol adherence • Provide onsite coaching and mentoring • Coordinate with administration • Encourage staff communication and transparency via progress boards The scale-up of resuscitation training and support activities followed the April 2018 TOT and continued for the next twenty-three months. Minimal key metrics of importance to NHTC were monitored to help measure the scale-up process and improvements in outcomes. The data collection was conducted according to Nepali months, comprising Chaitra 2074 through Falgun 2075, in accordance with MOHP convention (March 15, 2018 to March 14, 2020). Program monitoring and data collection Monthly training supervision reports generated by the program coordinator documented the scale-up and facility support, including the number of providers trained and retrained, maintenance of an equipped practice corner and low-dose high-frequency practice logs, completion of self-evaluation forms, review meetings held, and review of delivery and newborn logs. Monthly facility-level metrics were also collected from each facility, including the number of vaginal deliveries, number of caesarean sections, number of intrapartum (fresh) and macerated stillbirths, number of neonatal deaths less than 24 hours, number of sick newborns transferred or discharged from the maternity unit. DOI: 10.23937/2469-5769/1510087 ISSN: 2469-5769 Naresh et al. Int J Pediatr Res 2022, 8:087 • Page 4 of 9 • health centers, and health posts combining for about 25% of the total deliveries. Medical college metrics were disproportionally greater for neonatal deaths less than 24 hours (158 or 39.5%), intrapartum stillbirths (219 or 37.1%), discharge or transfer of sick newborns (1,821 or 36%), and Caesarean sections (5460 or 42.6%). The zonal hospitals represent the highest level of care in the public system. Neonatal deaths less than 24 hours, intrapartum stillbirths, and discharge/transfer of sick newborns were disproportionately lower in these facilities. The health posts and primary health centers did not provide Caesarean sections, yet their metrics were generally proportional to their contribution to the total number of deliveries. Outcomes according to facility type are listed in Table 2. Overview of perinatal events The cohort included 18 facilities. During the program, there were 49,809 vaginal deliveries and 12,823 Caesarian sections, for a total of 62,632 births included in the facility monitoring. The total number of births assessed in the comparison between beginning and follow-up measurements was 15,947. Analysis of this cohort suggested that the SSN program for emergency newborn care improvement was associated with decreases in the number of neonatal deaths less than 24 hours, in the number of intrapartum stillbirths, and in the number of sick newborns transferred or discharged from the maternity unit. Table 1 summarizes the number of deliveries, personnel trained, and the change in outcome indicators in this comparison. entire cohort of facilities, was approved by the Nepal Health Research Council. The registration number is 797/2018. An SSN supervisor submitted monthly reports and periodic formal presentations to the Social Welfare Council and the