***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background . Based on the general bonding hypothesis , it is suggested that kangaroo mother care ( KMC ) creates a climate in the family whereby parents become prone to sensitive caregiving . The general hypothesis is that skin-to-skin contact in the KMC group will build up a positive perception in the mothers and a state of readiness to detect and respond to infant 's cues . Method . The r and omized controlled trial was conducted on a set of 488 infants weighing < 2001 g , with 246 in the KMC group and 242 in the traditional care ( TC ) group . The design allows precise observation of the timing and duration of mother – infant contact , and takes into account the infant 's health status at birth and the socioeconomic status of the parents . Bonding Assessment . Two series of outcomes are assessed as manifestations of a mother 's attachment behavior . The first is the mother 's feelings and perceptions of her premature birth experience , including her sense of competence , feelings of worry and stress , and perception of social support . The second outcome is derived from observations of the mother and child 's responsivity to each other during breastfeeding at 41 weeks of gestational age . Interventions . KMC has three components . The first is the kangaroo position . Once the premature infant has adapted to extrauterine life and is able to breastfeed , he is positioned on the mother 's chest , in a upright position , with direct skin-to-skin contact . The second component is kangaroo nutrition . Although breastfeeding is the prime source of nutrition , infants also may receive preterm formula whenever necessary and vitamin supplements . The third component is the clinical control ; infants are monitored on a regular basis , daily until they are gaining at least 20 g per day . Afterward , weekly clinic visits are scheduled until term , which constitutes the ambulatory minimal neonatal care . In the TC group , infants are kept in incubators until they are able to self-regulate their temperature and are thriving ( ie , have an appropriate weight gain ) . Infants are discharged according to current hospital practice , usually not before their weight is ∼1700 g. Afterward , as with the KMC group , weekly clinic visits are scheduled until term . Results . We observed a change in the mothers ' perception of her child , attributable to the skin-to-skin contact in the kangaroo-carrying position . This effect is related to a subjective “ bonding effect ” that may be understood readily by the empowering nature of the KMC intervention . Moreover , in stressful situations when the infant has to remain in the hospital longer , mothers practicing KMC feel more competent than do mothers in the TC group . This is what we call a resilience effect . In these stressful situations we also found a negative effect on the feelings of received support of mothers practicing KMC . We interpret this as an isolation effect . To thwart this deleterious effect , we would suggest adding social support as an integral component of KMC . The observations of the mothers ' sensitive behavior did not show a definite bonding effect , but rather a resilience effect . This is attributable to the KMC intervention ; mothers practicing KMC were more responsive to an at-risk infant whose development has been threatened by a longer hospital stay . Otherwise , we observed that the mothers ( in both the KMC group and the TC group ) had behavioral patterns that were adapted to the child 's at-risk health status and to the precarious condition of some premature infants requiring intensive care . We conclude that the infant 's health status may be a more prominent factor in explaining a mother 's more sensitive behavior , which overshadows the kangaroo-carrying effect . Conclusion . These results suggest that KMC should be promoted actively and that mothers should be encouraged to use it as soon as possible during the intensive care period up to the 40 weeks of gestational age . Thus , KMC should be viewed as a means of humanizing the process of giving birth in a context of prematurity . This finding confirms the conclusions of the 1996 Trieste workshop suggesting that KMC should be promoted both in hospitals and after early discharge OBJECTIVE This study assessed the impact of a  nurse simulation training program  on perception of kangaroo mother care ( KMC ) value and transfer skill competency . STUDY DESIGN An 8-item Likert scale skill survey tool and a 24-item Likert developmental care survey tool were used in a prospect i ve cohort study to analyze perceptions of 30 neonatal nurses who underwent a comprehensive KMC simulation-based training program .  Competency skills were evaluated pretraining and tracked by direct observation for 6 months posttraining . Pre- and postsurvey data were analyzed and KMC utilization for preterm infants born at ≤ 34 weeks ' gestation was determined . RESULTS Nurses ' competency in infant transfer improved , especially in infants receiving nasal continuous positive airway pressure or ventilator support , from 30 to 93 % or 10 to 50 % , respectively , p < 0.0001 .  Neonatal nurses ' perceived KMC value increased from 50 to 100 % , p < 0.001 , and parent KMC utilization increased from 26.5 to 85.9 % , p < 0.0001 . Nurses ' support for parental visitation improved from 38 to 73 % , p < 0.001 ; discussion of KMC with parents on the 1st day increased from 5 to 45 % , p < 0.001 ; and initial day of KMC provision improved from 18.0 ± 2.7 to 5.6 ± 1.2 days , p < 0.001 . CONCLUSIONS A comprehensive simulation-based KMC education program  improved nurses ' perception of KMC value , their competency and comfort in infant transfer for KMC care , and successfully promoted KMC parent utilization for the preterm infant in the neonatal intensive care unit BACKGROUND . Sleep is important to brain organization , but few strategies to promote sleep among premature infants have been tested . Behaviorally based measures of sleep have shown increased quiet sleep ( QS ) and decreased active sleep ( AS ) during skin-to-skin contact ( SSC ) with the mother , but these results have not been confirmed with objective electroencephalographic/polysomnographic measures of sleep organization . Important differences exist between behavioral and electroencephalographic/polysomnographic definitions of sleep state . METHODS . Data for the first 28 relatively healthy , preterm subjects of an ongoing r and omized trial of one 2- to 3-hour session of SSC or incubator care between feedings are reported here . Infants were positioned prone , inclined , and nested in an incubator during the 2- to 3-hour pretest period , were fed , and then went into the test period of SSC or incubator care . Infants were left largely undisturbed throughout testing . A mixed-model regression analysis compared the test-pretest differences in outcome measures within and between groups . RESULTS . Results showed that arousals were significantly lower in the SSC group , compared with the control group , for the entire study period and for test-pretest matched segments of QS and AS . Rapid eye movement was significantly lower for the SSC group for the study period and AS segments . Indeterminate sleep was significantly lower for the SSC group when confounding environmental variables were included in the regression analysis . When 4 subjects who experienced excessive ambient light levels during SSC were removed from analysis , QS increased during SSC . CONCLUSIONS . The patterns demonstrated by the SSC group are analogous to more-mature sleep organization . SSC may be used as an intervention to improve sleep organization in this population of preterm infants Background 39 % of neonatal deaths in India occur on the first day of life , and 57 % during the first three days of births . However , the association between postnatal care ( PNC ) for newborns and neonatal mortality has not hitherto been examined . The paper aims to examine the association of PNC for newborns with neonatal mortality in India . Methods Data from District Level Household Survey , waive three ( DLHS-3 ) conducted in 2007–08 is utilized in the study . We used conditional logit regression models to examine the association of PNC with neonatal mortality . The matching variables included birth order and the age of the mother at the birth of the newborn . Results The findings suggest no association between check-up of newborns within 24 hours of birth and neonatal mortality . However , the place where the newborns were examined was significantly associated with neonatal mortality . Moreover , findings do reveal that children of mothers who were advised on ‘ keeping baby warm ( kangaroo care ) after birth ’ during their antenatal sessions were significantly less likely to die during the neonatal period compared to those children whose mothers were not advised about the same . Conclusions The findings are relevant because ‘ keeping baby warm ’ is one of the most cost-effective and easiest interventions to save babies from dying during the neonatal period . Though r and omized controlled trials have already demonstrated the effectiveness of ‘ keeping baby warm ’ , for the first time this has been found effective in a large-scale population -based study . The findings are of immense value for a country like India where the neonatal mortality rates are unacceptably high Objective : Despite the benefits of mother-newborn skin-to-skin contact ( SSC ) immediately after birth , the process has not been universally implemented as routine care for healthy term neonates . The purpose of this study was to determine opinions of the  midwives  about enabling factors of SSC immediately after birth in Tehran hospitals in 2012- 2013 . Material s and methods : This study has been conducted in a descriptive method based on PRCEDE-PROCEED model . The sample s were 292 midwives from 18 hospitals . We used stratified and then simple r and om sampling . In this study midwives were working at delivery room ; deliveries were conducted by midwives or they were in charge of the newborn immediately after birth . Data collection instrument was a self developed question naire concerning the enabling factors in the SSC . We applied face and content validity ratio ( CVR ) , content validity index ( CVI ) and item impact method for the instrument 's validity and Cronbach 's Alpha for reliability . Finally , data were analyzed and interpreted using spss-18 through descriptive statistics . Results : The results show that 90.4 % of the midwives believed in necessity of a plan , 96.2 % believed that good services should be provided to mothers , and 97.9 % , 85.3 % and 93.8 % of them believed there is a need for private space , essential facilities and essential equipment for skin contact process ; with Cronbach 's Alpha of 0.731 , 0.551 , 0.501 , and 0.600 respectively . Conclusion : Most of the midwives believed that enabling factors concerning the successful SSC are effective . We suggest further studies on other enabling factors effective in SSC from the view point of midwives , gynaecologists and caregivers Background Scaling up the implementation of new health care interventions can be challenging and dem and intensive training or retraining of health workers . This paper reports on the results of testing the effectiveness of two different kinds of face-to-face facilitation used in conjunction with a well- design ed educational package in the scaling up of kangaroo mother care . Methods Thirty-six hospitals in the Provinces of Gauteng and Mpumalanga in South Africa were targeted to implement kangaroo mother care  and participated in the trial . The hospitals were paired with respect to their geographical location and annual number of births . One hospital in each pair was r and omly allocated to receive either ' on-site ' facilitation ( Group A ) or ' off-site ' facilitation ( Group B ) . Hospitals in Group A received two on-site visits , whereas delegates from hospitals in Group B attended one off-site , ' h and s-on ' workshop at a training hospital . All hospitals were evaluated during a site visit six to eight months after attending an introductory workshop and were scored by means of an existing progress-monitoring tool with a scoring scale of 0–30 . Successful implementation was regarded as demonstrating evidence of practice ( score > 10 ) during the site visit . Results There was no significant difference between the scores of Groups A and B ( p = 0.633 ) . Fifteen hospitals in Group A and 16 in Group B demonstrated evidence of practice . The median score for Group A was 16.52 ( range 00.00–23.79 ) and that for Group B 14.76 ( range 07.50–23.29 ) . Conclusion A previous trial illustrated that the implementation of a new health care intervention could be scaled up by using a carefully design ed educational package , combined with face-to-face facilitation by respected re source persons . This study demonstrated that the site of facilitation , either on site or at a centre of excellence , did not influence the ability of a hospital to implement KMC . The choice of outreach strategy should be guided by local circumstances , cost and the availability of skilled facilitators OBJECTIVE . We adapted kangaroo mother care for immediate postnatal community-based application in rural Bangladesh , where the incidence of home delivery , low birth weight , and neonatal and infant mortality is high and neonatal intensive care is unavailable . This trial tested whether community-based kangaroo mother care reduces the overall neonatal mortality rate by 27.5 % , infant mortality rate by 25 % , and low birth weight neonatal mortality rate by 30 % . METHODS . Half of 42 unions in 2 Bangladesh divisions with the highest infant mortality rates were r and omly assigned to community-based kangaroo mother care  , and half were not . One village per union was r and omly selected proportionate to union population size . A baseline survey of 39888 eligible consenting women collected sociodemographic information . Community-based workers were taught to teach community-based kangaroo mother care to all expectant and postpartum women in the intervention villages . A total of 4165 live births were identified and enrolled . Newborns were followed for 30 to 45 days and infants were followed quarterly through their first birthday to record infant care , feeding , growth , health , and vital status . RESULT 
    Output:
    
Kangaroo mother care was applied in different ways in different context s. The studies show that there are several barriers to implementing kangaroo mother care , including the need for time , social support , medical care and family acceptance .
Barriers within health systems included organization , financing and service delivery .
In the broad context , cultural norms influenced perceptions and the success of adoption .
CONCLUSION Kangaroo mother care is a complex intervention that is behaviour driven and includes multiple elements .