the aim of the present study is to identify relevant indicators for assessing newborn care in hospitals by a systematic review . a search on electronic data base and manual searches of personal files for studies on quality indicators of newborn care were carried out . searching 9 bibliographic databases , we found 85 articles of which 22 exactly related ones were selected and studied . a list of 87 structure , process and outcome indicators was formulated from the articles . also 26 excess measures were identified in gray literature . after removing duplicates , and categorizing in 3 domains , these 93 indicators provide a framework for assessing how well the hospitals are providing neonatal care . these measures should be discussed in each context expert panels to address nationally applicable indices of neonatal care and may be adapted for local health settings . neonatal mortality rate is declining globally and fell from 40 to 33 deaths per 1,000 live births between 1990 and 2013 . in iran it fell from 27 to 10 in this time period and accounts for more than half of the under-5-year child mortality ( 1 - 3 ) . evidences from trend studies show that neonatal mortality decline has slowed down and neonatal deaths account for a larger share of u5mr ( 4 ) . the office for neonatal health in iranian ministry of health developed and implemented various plans to improve the healthy and also sick newborn care . health care systems seeking quality and accountability need to assess the performance of facilities and monitoring changes to display trends in measures . assessments are needed at every level of health care from community setting to level iii referral hospitals . the point is to identify what should be assessed . an author introduced  quality black box because it is extremely difficult to exactly measure what must be measured as a quality indicator ( 5 ) . donabedian s categorization of measurement of quality consisting of indicators for structure ( personal characteristics and institutional features ) , process ( activities in providing care ) , and outcome ( result of care ) is an accepted approach ( 6 ) . nine bibliographic data bases , 4 iranian ( sid , irandoc , magiran , medlib ) and 5 international ( pubmed , sciencedirect , googlescholar , scopus and cochrane ) , were searched . multiple combinations of keywords were used : neonatal care , perinatal care , newborn care , quality , quality indicators , evaluation , evaluation mechanism , assessment , quality assessment and performance . gray literature search was done on the world health organization ( who ) , american academy of pediatrics and iranian ministry of health websites . researchers reviewed the title and abstracts independently and in a sitting selected abstracts which did not met exclusion criteria for full text review . exclusion criteria were : not reporting neonatal care measures and non - persian / english language . at the next stage references cited in retrieved articles were also searched and screened . those papers that actually met the inclusion criteria were included in the study ( table 1 ) . the process of searching bibliographic data bases , selection and number of papers retrieved in each phase is shown in figure 1 . reviewing the papers , 87 indicators were extracted . among them , 13 were duplicates . remaining measures were classified in input ( n = 14 ) , process ( n = 31 ) , and outcome measures ( n = 29 ) . assessing the hand searched documents 25 indicators were derived of which 7 were duplicates . considering the 18 input indices , 41 process and 34 output indices were obtained ( table 2 ) . this is the systematic review with the main aim of providing a tool for evaluating quality of neonatal care in hospitals at any level . we considered infrastructure , equipment and staff as input , admission , treatment , care practices , referral , discharge and follow up as process indices . the structural factors are essential for quality of care in health care facilities , yet it is clear that these aspects are not sufficient to assure high quality , as currently , process and outcome measures are more emphasized . as can be seen , much of the proposed or applied indicators are in the process group , indicating the importance of components of good care . according to this criterion , a health care setting should be assessed by reviewing medical records , direct observations and interviews with care provider and recipients to determine to what extent the provided care is acceptable according to the level of facility . first the measuring , which is more complicated than the other two categories and require assessing multiple sources for data extraction - the accuracy of which is questionable - that lessen the feasibility . the other point is that the standard care is so variable among different areas of the world and in one and the same place would differ over time . actually some authors recommend to choose those process measures that scientific evidence illustrates they link to improved outcomes ( 25 , 26 ) . although such measures have traditionally been mortality and morbidity , outcomes research in recent years has expanded the measures to include patients perception of their health status and the services ( technical care and also interpersonal relationship ) that they receive . the point that must be considered is that determining health care outcome at discharge will miss some complications that appear just after discharge and we should think of recording patient s data after discharge at follow up care . presumably there are some indicators that havent been mentioned and some of which do not fit the iranian settings . therefore , qualitative studies are required to obtain the expert s opinion and integrate both results to make a list of appropriate measures for evaluation of quality of perinatal care provided in iranian settings .
context : neonatal mortality rate is declining globally . 
 the aim of the present study is to identify relevant indicators for assessing newborn care in hospitals by a systematic review.evidence acquisition : a search on electronic data base and manual searches of personal files for studies on quality indicators of newborn care were carried out . searching 9 bibliographic databases 
 , we found 85 articles of which 22 exactly related ones were selected and studied . 
 hand search yielded 1 record were also searched and 2 records were included.results:a list of 87 structure , process and outcome indicators was formulated from the articles . 
 also 26 excess measures were identified in gray literature . after removing duplicates , and categorizing in 3 domains , 
 18 measures were input , 41 process and 34 outcome measures.conclusions:these 93 indicators provide a framework for assessing how well the hospitals are providing neonatal care . 
 these measures should be discussed in each context expert panels to address nationally applicable indices of neonatal care and may be adapted for local health settings .