***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: OBJECTIVE . Skin barrier therapy during the neonatal period , when the skin barrier is most highly compromised and the risk of death is greatest , has been shown to have a number of potential benefits , including reduced risk of nosocomial sepsis . Topical application of emollients that augment skin barrier function was evaluated as a strategy for improving survival rates among hospitalized preterm infants in Bangladesh . METHODS . A prospect i ve , r and omized , controlled , clinical trial was conducted in the special care nursery at Dhaka Shishu ( Children ) Hospital , the largest tertiary care children 's hospital in Bangladesh . Preterm infants ( gestational age : ≤33 weeks ; N = 497 ) received daily topical applications of sunflower seed oil or Aquaphor ointment . Neonatal mortality rates were compared in an intent-to-treat analysis with a control group that did not receive emollient therapy . RESULTS . Treatment with sunflower seed oil result ed in a statistically significant 26 % reduction in mortality rates , compared with infants not receiving topical emollient therapy . Aquaphor therapy also significantly reduced mortality rates , by 32 % . CONCLUSIONS . Topical therapy with skin barrier-enhancing emollients  improved survival rates among preterm hospitalized infants in Bangladesh . This study provides strong evidence for the implementation of topical therapy for high-risk preterm neonates in developing countries BACKGROUND This study was conducted to estimate the  neonatal tetanus ( NNT ) mortality rate and to identify the risk factors for NNT deaths  in Loralai District , Pakistan . METHOD We conducted a community-based cross-sectional survey during July-September 1997 . We stratified the sample proportionate to population of union councils . The most populous village in a union council was selected first . We interviewed the women , selected r and omly , who had a live birth in the 18 months preceding the survey . We conducted a matched case-control study to identify the risk factors for NNT deaths . We used the World Health Organization criteria to enrol cases , identified during the cross-sectional survey or registered at the district hospital . We enrolled three community-based controls  per case , matched on the area of residence , immunization status and date of birth . RESULTS Of the 1547 live births , there were 36 neonatal deaths due to tetanus . The NNT mortality rate in the district was 23 per 1000 live births ( 95 % CI : 16 - 30 ) . For the case-control study , we enrolled 41 cases and 123 controls . Using conditional logistic regression , the risk of NNT death was increased with the use of soil as delivery surface ( O.R = 3.2 , 95 % CI : 1.1 - 10.2 ) , father 's illiteracy ( OR = 3.2 , 95 % CI : 1.3 - 8.1 ) and possession of sheep at home ( OR = 2 , 95 % CI : 1.0 - 5.0 ) . The population attributable risk per cent for soil as delivery surface was 64 % . CONCLUSION Transmission of infection while using soil as the delivery surface can occur through direct or indirect contamination of the fresh umbilical wound . Use of safer delivery practice s in general and clean surfaces in particular should be encouraged to reduce the NNT mortality rate in the area BACKGROUND More than 95 % of neonatal deaths occur in developing countries , approximately 50 % at home . Few data are available on the impact of h and -washing practice s by birth attendants or caretakers on  neonatal mortality . OBJECTIVE To evaluate the relationship between birth attendant and maternal h and -washing practice s and  neonatal mortality  in rural Nepal . DESIGN Observational prospect i ve cohort study . SETTING Sarlahi District in rural southern Nepal . PARTICIPANTS Newborn infants were originally enrolled in a community-based trial assessing the effect of skin and /or umbilical cord cleansing with chlorhexidine on neonatal mortality in southern Nepal . A total of 23,662 newborns were enrolled and observed through 28 days of life . MAIN EXPOSURES Question naires were administered to mothers on days 1 and 14 after delivery to identify care practice s and risk factors for mortality and infection . Three h and -washing categories were defined : ( 1 ) birth attendant h and washing with soap and water before assisting with delivery , ( 2 ) maternal h and washing with soap and water or antiseptic before h and ling the baby , and ( 3 ) combined birth attendant and maternal h and washing . OUTCOME MEASURES Mortality within the neonatal period . RESULTS Birth attendant h and washing was related to a statistically significant lower mortality rate among neonates ( adjusted relative risk [ RR ] = 0.81 ; 95 % confidence interval [ CI ] , 0.66 - 0.99 ) , as was maternal h and washing ( adjusted RR = 0.56 ; 95 % CI , 0.38 - 0.82 ) . There was a 41 % lower mortality rate among neonates exposed to both h and -washing practice s ( adjusted RR = 0.59 ; 95 % CI , 0.37 - 0.94 ) . CONCLUSIONS Birth attendant and maternal h and washing with soap and water were associated with significantly lower rates of neonatal mortality . Measures to improve or promote birth attendant and maternal h and washing could improve neonatal survival rates Background The World Health Organization recommends dry cord care for newborns but this recommendation may not be optimal in low re source setting s where most births take place in an unclean environment and infections account for up to half of neonatal deaths . A previous trial in Nepal indicated that umbilical cord cleansing with 4.0 % chlorhexidine could substantially reduce mortality and omphalitis risk , but policy changes await additional community-based data . Methods The Projahnmo Chlorhexidine study was a three-year , cluster-r and omized , community-based trial to assess the impact of three cord care regimens on neonatal mortality and omphalitis .  Women were recruited mid-pregnancy , received a basic package of maternal and neonatal health promotion messages , and were followed to pregnancy outcome . Newborns were visited at home by local village-based workers whose areas were r and omized to either 1 ) single- or 2 ) 7-day cord cleansing with 4.0 % chlorhexidine , or 3 ) promotion of dry cord care as recommended by WHO . All mothers received basic messages regarding h and -washing , clean cord cutting , and avoidance of harmful home-base applications to the cord . Death within 28 days and omphalitis were the primary outcomes ; these were monitored directly through home visits by community health workers on days 1 , 3 , 6 , 9 , 15 , and 28 after birth . Discussion Due to report in early 2010 , the Projahnmo Chlorhexidine Study examines the impact of multiple or single chlorhexidine cleansing of the cord on neonatal mortality and omphalitis  among newborns of rural Sylhet District , Bangladesh . The results of this trial will be interpreted in conjunction with a similarly design ed trial previously conducted in Nepal , and will have implication s for policy guidelines for optimal cord care of newborns in low re source setting s in Asia . Trial Registration Clinical Trials.gov ( NCT00434408 Background Every year four million babies die in the first month of life and a quarter of these take place in India . A package of essential newborn care practice s exists , which has a proven impact on reducing mortality , and can be implemented in low re source setting s. However , childbirth and the neonatal period are culturally important times , during which there is strong adherence to traditional practice s. Successful implementation of the package therefore requires in-depth knowledge of the local context and tailored behaviour change communication . Methods This study was carried out in rural Karnataka , India . It uses quantitative data from a prospect i ve survey following mothers through their experience of pregnancy and the postnatal period ; and qualitative data from in depth interviews and focus group discussion s conducted with mothers , gr and mothers and birth attendants . It explores local newborn care practice s and beliefs , analyses their harmful or beneficial characteristics and eluci date s areas of potential resistance to behaviour change and implementation of the essential newborn care package . Results Findings show that many potentially harmful newborn care practice s are being carried out in the study area , such as unhygienic cord cutting , delayed breastfeeding and early bathing . Some are more amenable to change than others , depending on the strength of the underlying beliefs , and acceptability of alternative care . However , movement away from traditional practice s is already taking place , particularly amongst the more educated and better off , and there is a clear opportunity to broaden , direct and accelerate this process . Conclusion Community education should be a focus of the National Rural Health Mission ( NRHM ) and Integrated Management of Neonatal and Childhood Illness ( IMNCI ) program being implemented in Karnataka . The added capacity of the new Accredited Social Health Activists ( ASHAs ) could enable more women to be reached . With careful tailoring of behaviour change messages to the local context , government outreach workers can become effective brokers of positive change and significant improvements in home newborn care and neonatal mortality are possible BACKGROUND Neonatal deaths in developing countries make the largest contribution to global mortality in children younger than 5 years . 90 % of deliveries in the poorest quintile of households happen at home . We postulated that a community-based participatory intervention could significantly reduce neonatal mortality rates . METHODS We pair-matched 42 geopolitical clusters in Makwanpur district , Nepal , selected 12 pairs r and omly , and r and omly assigned one of each pair to intervention or control . In each intervention cluster ( average population 7000 ) , a female facilitator convened nine women 's group meetings every month . The facilitator supported groups through an action-learning cycle in which they identified local perinatal problems and formulated strategies to address them . We monitored birth outcomes in a cohort of 28?931 women , of whom 8 % joined the groups . The primary outcome was neonatal mortality rate . Other outcomes included stillbirths and maternal deaths , uptake of antenatal and delivery services , home care practice s , infant morbidity , and health-care seeking . Analysis was by intention to treat . The study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N31137309 . FINDINGS From 2001 to 2003 , the neonatal mortality rate was 26.2 per 1000 ( 76 deaths per 2899 livebirths ) in intervention clusters compared with 36.9 per 1000 ( 119 deaths per 3226 livebirths ) in controls ( adjusted odds ratio 0.70 [ 95 % CI 0.53 - 0.94 ] ) . Stillbirth rates were similar in both groups . The maternal mortality ratio was 69 per 100000 ( two deaths per 2899 livebirths ) in intervention clusters compared with 341 per 100000 ( 11 deaths per 3226 livebirths ) in control clusters ( 0.22 [ 0.05 - 0.90 ] ) . Women in intervention clusters were more likely to have antenatal care , institutional delivery , trained birth attendance , and hygienic care than were controls . INTERPRETATION Birth outcomes in a poor rural population improved greatly through a low cost , potentially sustainable and scalable , participatory intervention with women 's groups OBJECTIVE To compare perinatal mortality , stratified for risk level , in home births attended by a relative or traditional birth attendant without formal training with births attended by trained personnel in a dispensary or hospital . STUDY DESIGN A prospect i ve community based study in five villages in Northwestern Tanzania during 1990 , involving 222 women delivering at home and 199 in a dispensary or hospital . RESULTS Twenty-two of the 29 ( 76 % ) perinatal deaths occurred in home births . Perinatal mortality , stratified for risk level , was three times higher in home births than it was in births in dispensaries or in hospital ( Mantel-Haenszel odds ratio , 3.29 ; 95 % CI , 1.28 - 9.22 ) . CONCLUSIONS This study re-emphasises that all births should be attended by adequately trained personnel . More effective strategies are needed to convince women with high risk pregnancies to deliver in hospital . Emergency referral services are required to deal with unexpected complications arising in low risk births at home OBJECTIVE : We found a high burden of morbidities in a cohort of neonates observed in rural Gadchiroli , India . We hypothesised that interventions would reduce the incidence of neonatal morbidities , including the seasonal increase observed in many of them . This article reports the effect of home-based neonatal care on neonatal morbidities in the intervention arm of the field trial by comparing the early vs late periods , and the possible explanation for this effect . METHODS : During 3 years ( 1995 to 1998 ) ,  trained village-health-workers ( VHWs ) in 39 villages prospect ively collected data by making home visits during pregnancy , home-delivery and during neonatal period . We estimated the incidence and burden of neonatal morbidities over the 3 years from these data . In the first year , the VHWs made home visits only to observe . From the second year , they assisted mothers in neonatal care and managed the sick neonates at home . Health education of mothers and family members , individually and in group , was added in the third year . We measured the coverage of interventions over the 3 years and evaluated maternal knowledge and practice s on 21 indicators in the third year . The effect on 17 morbid 
    Output:
    
No relationship was found between birth place and cord infections or sepsis mortality .
Conclusion According to expert opinion , clean birth and particularly postnatal care practice s are effective in reducing neonatal mortality from sepsis and tetanus .