In the First Breath study, the Neonatal Resuscitation Program intervention was assessed as a cluster-randomized controlled trial involving 62,366 infants in 88 communities in 5 countries (Guatemala, Pakistan, Democratic Republic of Congo, India, and Zambia). Birth attendants were trained in the basic knowledge and skills of resuscitation, initial steps of resuscitation, and bag-and-mask ventilation. The program interventions were associated with a decrease in the rate of still- birth but not with a decrease in the rate of perinatal death at 7 days of age. In all studies, cases of fresh stillbirth, when newborns appeared lifeless but were actually live born and in need of resuscitation, may have been misdiagnosed prior to training.