• health services research
• neonatology
• mortality
• global health

Nearly half of all the global under-five deaths take place during the neonatal period and 99% of them are in low-income and middle-income countries (LMICs). Preterm birth complications and neonatal encephalopathy account for majority of these deaths. Two recent multi-country randomised clinical trials to evaluate interventions to reduce these deaths have major implications on neonatal care in LMICs.

First, a WHO study investigated the impact of immediate kangaroo mother care (iKMC) on survival of low birth weight neonates weighing 1000–1799 g.1 In the intervention arm, neonatal intensive care units (NICUs) were redesigned for a family-centred care allowing treatment of neonates in zero separation from mother or a surrogate during the NICU stay. In the control arm, neonates received care as usual in an incubator with mothers giving brief KMC sessions at earliest 24 hours from birth. Neonates from both groups were moved to a usual KMC ward once deemed sufficiently stable for at least 24 hours. Median duration of the NICU stay was 6.4 days in both groups and during this time median daily skin-to-skin contact in the iKMC group was 16.9 hours and in the usual care group 1.5 hours. Neonates in the iKMC group had 25% reduction in the risk of 28-day (neonatal death) compared with the control arm (12.0% vs 15.7%, risk ratio (RR) 0.75; 95% CI 0.64 to 0.89).

Cochrane’s systematic review has shown that low birth weight neonates cared with KMC after stabilisation of some days to weeks have better survival and lower rates of sepsis and hypothermia …