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ABSTRACT. Background. Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children <5 years by two thirds, but this may be unattainable without halving newborn deaths, which now comprise 40% of all under-5 deaths. Greater emphasis on wide-scale implementation of proven, cost-effective measures is required to save women's and newborns' lives. Approximately 99% of neonatal deaths take place in developing countries, mostly in homes and communities. A comprehensive review of the evidence base for impact of interventions on neonatal health and survival in developingcountry communities has not been reported.Objective. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in communitybased neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning.Methods. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and neonatal health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies.Results. A paucity of community-based data was found from developing-country studies on health status impact for many interventions currently being considered for inclusion in neonatal health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health care.Conclusions. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn health. The results of this study provide a foundation for policies and programs related to maternal and newborn health and emphasizes the importance of health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy...

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We describe a term infant with congenital cutaneous candidiasis (CCC), and review all cases in the English literature that reported birth weight and outcome. Presence of an intrauterine foreign body was a predisposing factor for development of CCC and subsequent preterm birth. The most common presentation of CCC in neonates weighing >1000 g was a generalized eruption of erythematous macules, papules, and/or pustules that sometimes evolved to include vesicles and bullae. Extremely low birth weight, premature neonates weighing <1000 g most often presented with a widespread desquamating and/or erosive dermatitis (10 of 15 [67%]), and were at greater risk for systemic infection with Candida spp (10 of 15 [67%]) and death (6 of 15 [40%] than those weighing >1000 g (5 of 48 [10%]; 4 of 48 [8%], respectively). Systemic antifungal therapy is recommended for neonates with burn-like dermatitis attributable to Candida spp, or positive blood, urine, and/or cerebrospinal fluid cultures. Systemic treatment also should be considered for all infants with CCC who have respiratory distress in the immediate neonatal period and/or laboratory signs of sepsis such as an elevated leukocyte count with an increase in immature forms or persistent hyperglycemia and glycosuria.

Given the low cost (approximately .20 dollars for a course of therapy) and technologic simplicity of the intervention and the effect size observed in this study, a clinical trial with increased numbers of subjects is indicated to evaluate the potential of topical therapy to reduce infections and save newborn lives in developing countries.

Despite global declines in under-five and infant mortality rates in recent decades, neonatal mortality rates have remained relatively unchanged.1 Mortality during the first 28 days of life now accounts for two-thirds of deaths in children less than 1 year of age, and nearly four-tenths of all deaths in children less than 5 years of age.2 -4 A recent analysis found that the loss of healthy life from newborn deaths represented 8.2% and 13.6% of the burden of disease in Sub-Saharan Africa and South Asia, respectively, or 27 and 53 million years of life lost in those two respective regions alone. 5 The analysis, however, highlighted the dearth of information available on neonatal outcomes in developing countries, particularly at the community level, and the potential for currently available figures to underestimate the magnitude of the problem. Thus, epidemiological research is needed to make available more accurate data on risk factors and causes of neonatal morbidity and mortality, and improved and validated neonatal verbal autopsy instruments are needed in order to collect accurate data.For every death during the neonatal period, it is estimated that another stillbirth has occurred; when combined with the two-thirds of neonatal deaths that occur during the first week of life, perinatal deaths nearly equal the number of deaths during the entire first year of life. 6,7 Estimates from the World Bank suggest that perinatal deaths account for approximately 7% of the global burden of disease, exceeding that due to malaria and vaccine-preventable infections combined. 8 Worldwide, 98% of all neonatal deaths occur in developing countries, most often at home, outside the formal health care system, and largely due to infections (32%), birth asphyxia and injuries (29%), and consequences of prematurity and congenital anomalies (34%).9 Infections may account for approximately half of newborn deaths at the community level.10 Low birth weight (LBW) is an overriding factor in the majority of the deaths. 1Conditions that affect the neonate, including LBW, impact not only neonatal mortality but also long-term morbidity through effects on neurological and cognitive development and associations with chronic diseases such as diabetes, cardiovascular disease and chronic lung disease.11 Thus, interventions that prevent morbidity during the neonatal period have the potential to be highly cost-effective and impact health far beyond the neonatal period.In this review, we present a conceptual framework for maternal and neonatal health care, and in this context, propose priority research activities to improve perinatal and neonatal health and survival in developing country communities. CONCEPTUAL FRAMEWORK AND CONTEXT OF NEONATAL HEALTH CARE AND RESEARCHImproving newborn health and survival depends in large measure on more effectively implementing what we already know works.Although post -neonatal and child mortality rates have declined dramatically in many developing countries in recent decades, neonatal mortality rates have remained relati...