***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 . 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 In rural India , most births take place in the home , where high-risk care practice s are common . We developed an intervention of behaviour change management , with a focus on prevention of hypothermia , aim ed at modifying practice s and reducing neonatal mortality . METHODS We did a cluster-r and omised controlled efficacy trial in Shivgarh , a rural area in Uttar Pradesh . 39 village administrative units ( population 104,123 ) were allocated to one of three groups : a control group , which received the usual services of governmental and non-governmental organisations in the area ; an intervention group , which received a preventive package of interventions for essential newborn care ( birth preparedness , clean delivery and cord care , thermal care [ including skin-to-skin care ] , breastfeeding promotion , and danger sign recognition ) ; or another intervention group , which received the package of essential newborn care plus use of a liquid crystal hypothermia indicator ( ThermoSpot ) . In the intervention clusters , community health workers delivered the packages via collective meetings and two antenatal and two postnatal household visitations . Outcome measures included changes in newborn-care practice s and neonatal mortality rate compared with the control group . Analysis was by intention to treat . This study is registered as International St and ard R and omised Control Trial , number NCT00198653 . FINDINGS Improvements in birth preparedness , hygienic delivery , thermal care ( including skin-to-skin care ) , umbilical cord care , skin care , and breastfeeding were seen in intervention arms . There was little change in care-seeking . Compared with controls , neonatal mortality rate was reduced by 54 % in the essential newborn-care intervention ( rate ratio 0.46 [ 95 % CI 0.35 - 0.60 ] , p<0.0001 ) and by 52 % in the essential newborn care plus ThermoSpot arm ( 0.48 [ 95 % CI 0.35 - 0.66 ] , p<0.0001 ) . INTERPRETATION A socioculturally context ualised , community-based intervention , targeted at high-risk newborn-care practice s , can lead to substantial behavioural modification and reduction in neonatal mortality . This approach can be applied to behaviour change along the continuum of care , harmonise vertical interventions , and build community capacity for sustained development . FUNDING USAID and Save the Children-US through a grant from the Bill & Melinda Gates Foundation AIM To describe the outcomes of low-birth-weight babies using an ' early discharge ' Kangaroo care policy  and to identify barriers to their follow-up . METHODS Prospect i ve descriptive study of all 272 babies admitted to a Kangaroo Care Ward in Malawi from November 2003 to May 2004 . Infants were discharged to outpatient care once weighing over 1300 g and gaining weight . Follow-up was carried out until 2500 g. RESULTS Infants [ 201 of 272 ( 73.9 % ) ] reached a weight > 2500 g ; 46 out of 272 ( 16.9 % ) died ; outcome was unknown in 25 of 272 ( 9.2 % ) . Outpatient mortality was higher amongst discharges weighing under 1500 g [ RR = 2.41(1.25 - 4.63 ) P = 0.01 ] . Discharge below birth weight did not affect mortality [ RR = 0.77(0.40 - 1.46 ) P = 0.42 ] . Barriers identified to seeking healthcare post-discharge included transport problems and late recognition of illness . CONCLUSIONS Early discharge is safe and feasible , but issues regarding access to healthcare need to be addressed . Future research is needed to determine how best high mortality can be reduced in specific subgroups : notably infants < 1500 OBJECTIVE To test  paternal vs maternal kangaroo care ( KC ) to reduce pain from heel lance . DESIGN R and omized crossover design . SETTING Three university-affiliated level III neonatal intensive care units . PATIENTS Sixty-two preterm neonates at 28 to 36 weeks ' gestational age who were expected to stay in the neonatal intensive care unit for at least 2 blood sampling procedures , without major congenital anomalies , grade III or IV intraventricular hemorrhage , or periventricular leukomalacia ; without surgical interventions ; not receiving parenteral analgesics or sedatives within 72 hours ; and with parental consent . INTERVENTION During 2 separate medically ordered heel lance procedures at least 24 hours apart , infants were held in KC for 30 minutes before and during the procedure with the mother or with the father , and with the other parent in the subsequent session . Which parent came first was r and omized . MAIN OUTCOME MEASURES The Premature Infant Pain Profile and time for heart rate to return to baseline were the primary outcomes . RESULTS At 30 and 60 seconds after the heel lance , infants in maternal KC displayed significantly lower scores on the Premature Infant Pain Profile than when in paternal KC ( 30 seconds mean difference , 1.435 [ 95 % confidence interval , 0.232 - 2.632 ] ) ; 60 seconds mean difference , 1.548 [ 95 % confidence interval , 0.069 - 3.027 ] ) . At 90 and 120 seconds , there were no differences . The difference in time to return to KC heart rate before the heel lance was significant , with the time in maternal KC being 204 seconds and in paternal KC , 246 seconds ( mean difference , 42 seconds [ 95 % confidence interval , 5.16 - 81.06 seconds ] ) . CONCLUSIONS Mothers were marginally more effective than fathers in decreasing pain response . Future research should address feasibility issues and nonparent providers of KC during painful procedures . TRIAL REGISTRATION clinical trials.gov Identifier : IS RCT N51481987 OBJECTIVE To reveal mothers ' experiences of providing kangaroo care for their preterm newborns while still in the hospital . DESIGN Transcendental phenomenology was used to analyze the experiences of mothers providing kangaroo care for their preterm newborns . Tape recorded , semistructured interviews were conducted 1 to 4 weeks postpartum . Mothers were asked one gr and tour question , " What was it like for you to provide kangaroo care for your preterm infant while in the hospital ? " This study was the qualitative component of a r and omized clinical trial . PARTICIPANTS Ten women who provided kangaroo care for their preterm newborns , 32 - 36 completed weeks , weighing 1500 - 3000 grams , with APGAR scores 6 or greater at 1 minute , 7 or greater at 5 minutes . RESULTS Four dominant themes emerged . The themes were reduced to one essential structure of knowing . The two essential elements of the structure of knowing were mothers kept from knowing their preterm newborn and mothers getting to know their preterm newborn . CONCLUSIONS Kangaroo care facilitates bonding and enhances maternal-infant acquaintance , even in the neonatal intensive care unit ( NICU ) environment . Mothers found that kangaroo care  calmed them and their newborns OBJECTIVE : Working with a multidisciplinary team of Ecuadorians , Bangladeshis and Americans , we developed a simple protocol for community-based implementation of kangaroo mother care ( CKMC ) that does not require birth weight or clinical judgment to identify which newborns should receive CKMC . CKMC could stabilize newborns and possibly reduce neonatal mortality where there is little medical care for newborns and low birth weight ( LBW ) is common . STUDY DESIGN : During their CKMC training , community-based workers identified 35 expectant or recently delivered women in the pilot study area and taught them about CKMC .  Women were interviewed at 1 month postpartum to evaluate their experience with CKMC . RESULTS : In all , 77 % of mothers initiated skin-to-skin care and 85 % with LBW babies did so ( 37 % were LBW ) . CKMC mothers delayed newborn bathing . Few slept upright with their newborns . CONCLUSIONS : CKMC was quickly and popularly adopted . A r and omized controlled cluster trial is planned to determine whether CKMC reduces neonatal mortality OBJECTIVE To compare the kangaroo and traditional methods of removing an infant from an incubator in terms of four physiologic parameters , mother 's satisfaction , and mother 's preference . DESIGN Time-series design ( quasi-experimental ) , with infant-mother dyads subjected to both methods . SETTING Intermediate neonatal care unit in a tertiary hospital in Canada . PARTICIPANTS A convenience sample of 71 infant-mother dyads . INTERVENTION AND MEASURES : The intervention was use of the kangaroo or traditional method of maintaining body temperature of preterm infants . The dependent variables were physiologic parameters ( skin temperature , heart rate , respiratory rate , and oxygen saturation ) measured five times with each method . Mother 's satisfaction was measured at the end of each testing period and mother 's preference at the end of the experiment . RESULTS The kangaroo method produced less variation in oxygen saturation and longer duration of testing , and it was preferred by most of the mothers . CONCLUSIONS The kangaroo method is safe for the preterm infant and allows for early contact between parents and infants AIM To compare weight gain and head growth in very-low-birthweight ( VLBW , < 1501 g ) infants with or without exposure to short duration of skin-to-skin contact ( STSC ) during their stay in a neonatal intensive care unit . METHODS Stable VLBW infants were r and omised into either STSC or control group . Parents of the STSC group were encouraged to provide STSC for at least 1 h daily . RESULTS One hundred and forty-six infants were r and omised , but only 126 were enrolled ( STSC group : n = 64 ; CONTROLS n = 62 ) . Infants in the STSC group had better mean weekly increase in head circumference ( 1.0 cm ( SD = 0.3 ) vs. 0.7 cm ( SD = 0.3 ) ; P < 0.0001 ) and higher breastfeeding rate at discharge ( 29.7 % vs. 14.5 % ; P = 0.04 ) . Although the mean duration of maternal education was longer in STSC ( 13.0 vs. 12.1 years ; P = 0.04 ) than in controls , linear regression analysis showed that the significant predictors associated with weekly head growth were exposure to STSC ( unst and ardised coefficient : 0.2 ; 95 % confidence intervals ( CI ) : 0.1 , 0.3 ; P < 0.0001 ) and head circumference of infants at the time of enrollment ( unst and ardised coefficient : -0.05 ; 95 % CI : -08 , -0.03 ; P < 0.0001 ) ; the number of years of maternal education was not a significant predictor . Logistic regression analysis showed that the only significant predictors of successful breastfeeding at discharge were receiving expressed breast milk at enrollment ( adjusted OR : 4.1 ; 95 % CI : 1.4 , 11.7 ; P = 0.009 ) and receiving expressed breast milk during intervention period ( adjusted OR : 8.3 ; 95 % CI : 2.8 , 24.4 ; P < 0.0001 ) ; exposure to STSC and maternal education were not significant predictors . CONCLUSION Exposure to short duration of STSC may promote head growth in VLBW infants BACKGROUND R and omized clinical trials have shown that  Kangaroo Mother Care ( KMC ) can decrease morbidity and mortality due to low birthweight . Between 1994 and 2004 , 44 teams in 25 developing countries were trained in KMC in Bogotá , Colombia ; however , not all the teams were successful in 
    Output:
    
Furthermore , we identified barriers and enablers of KMC adoption by caregivers within the context of the health system regarding financing and service delivery .
Embedded within the broad social context , barriers to KMC adoption by caregivers included adherence to traditional newborn practice s , stigma surrounding having a preterm infant , and gender roles regarding childcare .