Introduction

Globally, 5.8 million children younger than 5 years died in 2015, including 2.6 million neonatal deaths.[1] This burden is especially relevant in sub-Saharan Africa and Southern Asia, which accounts for most of these deaths.[2] Despite overall improvements since 1990, the reduction of neonatal mortality in low-resource countries has been slower than the reduction of maternal and child mortality.[3,4] The day of birth and the early postnatal period are the most vulnerable phases for both mother and neonate.[5,6]
Overall, it is estimated that 15% to 20% of all births worldwide are low birth weight (LBW), representing more than 20 million births a year, the great majority of them reported in low- and middle-income countries.[7] LBW is also a major contributor to both neonatal and child mortality.[8]
Hypothermia is associated with neonatal morbidity and mortality in high and low-resource settings.[9-13] Thermal care is a critical and essential component of newborn care in low-resource settings where supportive care is limited.[9-13] Appropriate interventions include warm rooms, skin-to-skin care, protective clothes and breastfeeding.[14]
Kangaroo mother care (KMC) is a low-cost intervention that includes prolonged skin-to-skin contact (SSC) between mother and newborn, exclusive breastfeeding, early discharge from the health facility, and close follow-up at home.[15] KMC is strongly recommended because it may prevent many complications associated with preterm birth and may also provide benefits to full-term newborns.[16,17] The World Health Organization (WHO) guidelines recommend that during KMC the baby's head be covered with a hat/cap to prevent thermal dispersion, [18] but this practice is not consistently followed in low-resource settings. Previous studies suggested that the application of woolen hats may reduce the neonatal heat loss immediately after birth, but its effect