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Table 1 Neonatal kit components, utilization and evidence

From: The community-based delivery of an innovative neonatal kit to save newborn lives in rural Pakistan: design of a cluster randomized trial

Kit component Description Utilization Evidence
Clean birth kit (CBK) Contains a sterile blade to cut the umbilical cord, clean plastic square to be placed on the ground or other surface during birth, plastic gloves to be worn by the birth attendant, hand soap, and cord ties/clamp The expectant mother will be taught to provide the CBK to the traditional birth attendant (TBA) or other individual conducting the delivery Clean birth kits, when combined with education, are associated with reductions in newborn mortality and infection [12]
Expectant mothers will be instructed to take the CBK to health facilities where it may be used at the discretion of the health professional conducting the delivery
Chlorhexidine (CHX) solution Each kit will contain 15 mL of 4% CHX packaged into a small plastic dispensing bottle and accompanied by a bag of cotton balls Caregivers will be taught to apply a small amount of CHX to a cotton ball and to dab the wet cotton ball onto the umbilical stump and surrounding area once a day from day 1 to day 10 of the newborn’s life CHX is a topical antiseptic that exhibits broad-spectrum antimicrobial activity against both Gram-positive and Gram-negative bacterium
Umbilical-cord cleansing with CHX solution reduces the incidence of omphalitis and neonatal mortality [1316]
Sunflower oil emollient Each kit will contain 50 mL of sunflower oil emollient packaged into a small plastic dispensing bottle Caregivers will be taught to take a small amount of oil into their hands and massage the oil into the newborn’s skin all over their body once a day from day 3 until day 28 of the newborn’s life In facility-based studies, sunflower oil has been shown to protect against hospital-acquired infections in very low birth weight infants [17, 18] and improve survival rates in hospitalized preterm infants [19]
Mechanically extracted from raw sunflower seeds using an expeller press
ThermoSpot TM ThermoSpotTM is a small circular device ~12 mm in diameter that adheres to skin and allows for non-invasive, continuous thermal monitoring [20] Caregivers will be taught to apply one sticker to the axillary region of the newborn on their first day of life and to leave the sticker in place until it falls off on its own or until day 14 of life (if sticker falls off it will be replaced) Today, the acceptability and accuracy of ThermoSpotTM has been demonstrated in both hospital [2123] and community-based settings [24] within developing countries
ThermoSpotTM was obtained from Maternova (http://maternova.net)
ThermoSpotTM changes colour as temperature changes [25]
Device adheres to the skin for ~24 days [22] Caregivers will be taught that a bright green face (newborn temperature 36.5°C to 37.5°C) is normal; a blue face (temp >39.0°C) indicates fever and care should be immediately sought at a local health facility; a pale green and red faces (temp 35°C to 36°C) indicate moderate hypothermia; and, a black face (temp < 35°C) represents severe hypothermia
In the event of a pale green face, the caregiver will be instructed to initiate kangaroo care (hold the baby close to her skin), and frequently monitor temperature
In cases of moderate to severe hypothermia (red and black ThermoSpot), caregivers will be taught to place the infant in the Mylar sleeve with warmer and immediately take the newborn to the local health centre
Mylar infant sleeve One sterile Mylar infant sleeve will be included in each kit If ThermoSpotTM indicates moderate or severe hypothermia, caregivers will be taught to activate the non-electric warmer and place it at the bottom of the Mylar sleeve and then the newborn is to be placed in the sleeve  
Mylar infant sleeves were obtained from Maternova (http://maternova.net)
Once the newborn is in the Mylar sleeve, the caregiver is to immediately take the child to the nearest health facility for further management
Reusable instant heat pack Instant heat packs are pocket-sized, reusable, and placed in a fitted cloth pouch If ThermoSpotTM indicates moderate or severe hypothermia, the instant heat pack will be activated and placed, while still inside cloth pouch, at the base of Mylar infant sleeve  
Each heat pack contains a non-toxic salt-based solution and a small metallic disc
By flexing the metallic disc, an exothermic crystallization reaction is triggered, which keeps the temperature warm for ~20 to 30 minutes
Handheld battery operated weighing scale with suspended cloth sling Scale (Shenzhen Cyber Technology Ltd. Item # CT8831) will not be included with the kit but rather one will be issued to each LHW in the intervention cluster The LHW will be instructed to weigh the newborn at the first home visit after delivery  
The newborn will be weighed twice and the average of these two weights will be recorded as the birth weight