***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 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 : Preterm infants are prone to hypothermia immediately following birth . Among other factors , excessive evaporative heat loss and the relatively cool ambient temperature of the delivery room may be important contributors . Most infants < 29 weeks gestation had temperatures < 36.4 ° C on admission to our neonatal unit ( NICU ) . Therefore we conducted a r and omized , controlled trial to evaluate the effect of placing these infants in polyurethane bags in the delivery room to prevent heat loss and reduce the occurrence of hypothermia on admission to the NICU . METHODS : After parental consent was obtained , infants expected to be < 29 weeks gestation were r and omized to intervention or control groups just prior to their birth . Infants r and omized to the intervention group were placed in polyurethane bags up to their necks immediately after delivery before being dried . They were then resuscitated per NRP guidelines , covered with warm blankets , and transported to the NICU , where the bags were removed and rectal temperatures were recorded . Control infants were resuscitated , covered with warm blankets , and transported without being placed in polyurethane bags . Delivery room temperatures were recorded so this potentially confounding variable could be assessed . RESULTS : Intervention patients were less likely than control patients to have temperature < 36.4 ° C on admission , 44 vs 70 % ( p<0.01 ) and the intervention group had a higher mean admission temperature , 36.5 ° C vs 36.0 ° C ( p<0.003 ) . This effect remained significant ( p<0.0001 ) when delivery room temperature was controlled in analysis . Warmer delivery room temperatures ( ≥26 ° C ) were associated with higher admission temperatures in both intervention and control infants , but only the subgroup of intervention patients born in warmer delivery rooms had a mean admission temperature > 36.4 ° C . CONCLUSIONS : Placing infants < 29 weeks gestation in polyurethane bags in the delivery room reduced the occurrence of hypothermia and increased their NICU admission temperatures . Maintaining warmer delivery rooms helped but was insufficient in preventing hypothermia in most of these vulnerable patients without the adjunctive use of the polyurethane bags Objective : To describe the effects of out-of-hospital birth on early neonatal morbidity and outcome among referred newborns . Methods : Using a structured case record form , we prospect ively collected data on place of birth , morbidity , and outcome of all neonates admitted to the Emergency Ward , University College Hospital , Ibadan , in the first week of life . Results : Of the 541 admitted in the early neonatal period , 61.8 % and 38.2 % were delivered outside and inside the hospital setting , respectively . Babies were delivered at religious or " mission " house ( 46.7 % ) , house of residence ( 38.0 % ) , traditional birth attendants ' homes ( 8.4 % ) , and on the way to the hospital ( 6.9 % ) . Births outside the hospital significantly increased as the birth order increased ( χ = 34.04 ; P = 0.000 ) . Over half of the out-of-hospital deliveries took place under personnel whose primary responsibilities did not include labor care . Women who had less than secondary level of education and those from the lower social class were more likely to deliver outside the hospital ( P < 0.05 ) . Out-of-hospital births were significantly associated with many complications , namely , hypothermia ( 53.6 % ) , perinatal asphyxia ( 48.5 % ) , hemorrhage ( 26.5 % ) , cephalhematoma ( 12.9 % ) , prematurity ( 9.9 % ) , and neonatal tetanus ( 4.2 % ) . Neonatal mortality rate of 12.6 % in the out-of-hospital group was significantly higher than 6.3 % obtained in the hospital birth group ( P = 0.019 ) . Conclusions : Out-of-hospital births had greater risk of morbidity than hospital births . There is need to retrain and monitor the activities of birth attendants and midwives involved in births outside the hospitals closer than it is presently done The objective of this study is to correlate the severity of  hypothermia  in sick extramural neonates with fatality and physiological derangements . This is a prospect i ve observational study carried out at the referral neonatal unit of a teaching hospital admitting extramural neonates . The subjects comprised of 100 extramural hypothermic neonates transported to the Referral neonatal unit . Neonates weighing more than 1000 g , with abdominal skin temperature less than 36.5 degrees C at admission were included in the study . Hypothermia was classified as per WHO recommendations . Clinical features including age , weight , gestational age , clinical diagnosis , vitals , place of delivery , details of transportation and capillary filling time were recorded at the time of admission .  Oxygen saturation  was recorded by a pulse oximeter . Sample s for sepsis screen , blood culture and blood glucose were taken at admission . During the study it was observed that fatality was 39.3 % in mildly hypothermic babies , 51.6 % in moderately hypothermic babies and 80 % in severely hypothermic babies . However , the presence of associated illness ( birth asphyxia , neonatal sepsis and respiratory distress ) , physiological derangements ( hypoxia , hypoglycemia and shock ) and weight less than 2000 g were associated with more than 50 % fatality even in mildly hypothermic babies . When moderate hypothermia was associated with hypoxia or shock , the fatality was 83.3 % and 90.9 % respectively . Similarly , mild hypothermia with hypoglycemia was associated with 71.4 % fatality . The conclusion drawn from this study is that the WHO classification of severity of hypothermia  correlates with the risk of fatality . However , it considers only body temperature to classify severity of hypothermia . The presence of associated illness ( birth asphyxia , neonatal sepsis and respiratory distress ) , physiological derangements ( hypoxia , hypoglycemia and shock ) and weight less than 2000 g should be considered adverse factors in hypothermic neonates . Their presence should classify hypothermia in the next higher category of severity in WHO classification A prospect i ve cohort study was carried out at the University Teaching Hospital , Lusaka , Zambia , to investigate the prevalence of  neonatal hypothermia  , type of infant care  and incidence of mortality .  Two-hundred- and -sixty-one infants , aged 0 - 7 days , admitted to the pediatric unit during the ' warm ' season were recruited to the study . Forty-four per cent of the infants were hypothermic ( < 36 degrees C ) on admission , and admission hypothermia correlated to admission weight and home delivery in the youngest age group ( 0 - 24 hours ) . Exclusively breastfed infants ( age group 1 - 7 days ) were less likely to be hypothermic at admission . ' Hypothermia ' was not recorded as an admission diagnosis and no special attention was given to those infants in terms of clinical management . Mean time to reach a body temperature above 35.9 degrees C did not differ between infants kept in a cot and in an incubator . Total numbers of death was 82 ( 31 per cent ) and the mortality was higher in infants who were hypothermic at admission compared to those who were not . This study demonstrates that a change of existing care routines is needed OBJECTIVE To determine the incidence rate and factors associated with  hypothermia in Iranian newborns and to discover the effect of hypothermia on neonatal morbidity and mortality . METHODS We selected a r and om sample of 1952 neonates using a multistage sampling technique from February 2004 to February 2005 in University Teaching Hospitals in Iran . We measured repeatedly at different time points the rectal temperature of these newborns . At each time of measurement , those with rectal temperature < 36 degrees C were considered as hypothermic . RESULTS The obtained results showed that approximately one third of newborns became hypothermic immediately after birth . In addition , the regression analysis revealed that low birth weights , prematures , low apgar scores , infants of multiple pregnancies and those who received cardiopulmonary resuscitation had higher risk for being hypothermic . It was also found that  hypothermia  increases the risk of metabolic acidosis , jaundice , respiratory distress , hypoglycemia , pulmonary hemorrhage and death , regardless of the newborn 's weight and gestational age . CONCLUSION There is an urgent need to train mothers and all levels of neonatal care staff to control this health problem in our country Aim : To eluci date the impact of bathing on the prevalence of hypothermia among newborn babies exposed to the skin‐to‐skin ( STS ) care technique  before and after bathing . Methods : Non‐asphyxiated newborns after vaginal delivery ( n=249 ) in a Ug and an referral hospital were consecutively enrolled and r and omized either to bathing at 60 min postpartum ( n=126 ) or no bathing ( n=123 ) . All mothers practised skin‐to‐skin care of their newborns . Four rectal and tympanic registration s of newborn temperatures were carried out in both groups directly after drying at birth , and at 60 , 70 and 90 min postpartum . Results : Bathing of newborns in the first hour after delivery result ed in a significantly increased prevalence of hypothermia , defined as temperature < 36.5 ° C , at 70 and at 90 min postpartum despite the use of warmed water and the application of the STS method . There was no neonatal mortality . Aside from the bathing procedure , no background factor potentially predisposing the newborns to hypothermia was identified An assessment of the incubators in use at the Kathm and u Maternity Hospital neonatal unit was undertaken ; this was followed by a prospect i ve survey of neonatal temperatures on the unit . In the incubator assessment 11 studies were carried out in five incubators . Three of the thermostats in the five incubators did not work at all and those in the other two incubators were more than 3 degrees C inaccurate . All the incubator thermometers gave recordings less than the actual temperature ( with a range of error : 1.3 - 4.4 degrees C ) . Six out of the 11 babies studied were hypothermic ( defined as rectal temperature < 36 degrees C ) . In the prospect i ve survey of temperatures a high incidence of hypothermia was found on the neonatal unit at the time of first temperature measurement ( 64 per cent had a rectal temperature of < 36 degrees C ) . A significant association between admission hypothermia and mortality was noted . Sixteen per cent ( 10/64 ) of babies admitted with temperatures < 36 degrees C died within the first week , compared to 0 ( 0/36 ) of those admitted with temperatures > or = 36 degrees Objective To determine whether training  traditional birth attendants  to manage several common perinatal conditions could reduce  neonatal mortality in the setting of a re source poor country with limited access to healthcare . Design Prospect i ve , cluster r and omised and controlled effectiveness study . Setting Lufwanyama , an agrarian , poorly developed district located in the Copperbelt province , Zambia . All births carried out by study birth attendants occurred at mothers ’ homes 
    Output:
    
The introduction of simple hypothermia prevention messages and interventions into evidence -based , cost-effective packages for maternal and newborn care has promising potential to decrease the heavy global burden of newborn deaths attributable to severe infections , prematurity , and asphyxia .
Because preventing and treating newborn hypothermia in health institutions and communities is relatively easy , addressing this widespread challenge might play a substantial role in reaching Millennium Development Goal 4 , a reduction of child mortality