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Globally, about 28% of deaths among children less than 5 years old occur in the first week of life, so hopes of achieving the United Nations' Millennium Development Goal 4 (reduction in under-5s mortality by two-thirds between 1990 and 2015) must depend to some extent on reducing early neonatal mortality. The World Health Organization published its Essential Newborn Care course in 2006, focusing on routine neonatal care, resuscitation, thermoregulation, breast feeding, “kangaroo” skin-to-skin care, care of the small baby, and common illnesses. Now (New England Journal of Medicine 2010;362: 614–23) a large trial in rural communities in six developing countries has shown no reduction in early neonatal mortality but an improvement in perinatal mortality, after introduction of the United Nations (UN) course followed by a modified version of the American Academy of Pediatrics (AAP) Neonatal Resuscitation program. The UN course was used in a before-and-after study in Argentina, Democratic Republic of Congo, Guatemala, India, Pakistan, and Zambia (a total of 57643 infants) and followed by a cluster-randomised trial (62366 infants) of the APP programme in all of these countries except Argentina. Local instructors trained birth attendants (33% traditional birth attendants). After training using the UN course there was no change in early neonatal mortality (23 per 1000 live births) but the stillbirth rate fell significantly from 23 to 16 per 1000 total births. Some of this reduction may have been due to …

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