Nearly 750,000 newborns lives could be saved every year with specific interventions for small and sick newborns.

In order to achieve SDG 3 (to ensure healthy lives and promote well-being for all at all ages) focus is needed in improving care for every newborn, mainly in those who are born small (from prematurity or intrauterine growth restriction) or become ill. These babies are at high risk of dying or becoming disabled; an estimated 1 million of survivors in this group survive with a long-term disability.

Approximately 80% of the 2.4 million newborn deaths globally every year, are in low-birth-weight (LBW); two thirds of deaths happen in those born prematurely. Care in facilities for newborns is needed for the most common conditions, such as complications from prematurity, intrapartum brain injury, severe bacterial infection, pathological jaundice, and congenital conditions. (1)

Where is the improvement in care most needed?

Ninety-eight percent of neonatal deaths occur in low and middle-income countries, with 75% occurring in Southern Asia and sub-Saharan Africa (2). Of the 10 countries with the highest NMRs, eight are in Africa, where the majority have experienced a recent humanitarian crisis. In humanitarian settings, pregnant and post-partum women face enormous challenges to access care for themselves and for their newborns. These women are also at risk for malnutrition, sexual violence, poor mental health and unplanned pregnancies, as well as those related to births with no skilled attendants. (3)

In high-income countries (HICs), the neonatal mortality rate is usually low, and most small newborns survive and thrive. In middle-income countries (MICs), the risk of disability for infants born between 28 and 32 weeks of gestation is nearly double that of HICs, due to deficiencies in the quality of care. In low-income countries (LICs), disability is uncommon since the smallest and sickest newborns, usually die due to lack of access to essential care or more advanced care when needed. (4)

What is the care needed?

Most newborns can survive and thrive when good quality health care, including appropriate inpatient care, is available. In order to provide appropriate care for small and sick newborns, LMICs require improvements in inpatient care to reduce mortality and avoid long-term complications. High-quality inpatient care requires an adequate space, competent professionals in all areas, and equipment and supplies to deliver the care. All newborns require essential care, particularly at the time of birth and during the first days of life, whether in a health facility or at home. Most small and sick newborns require special inpatient care, which can only be provided in a health facility. Intensive care in a high-level referral facility is only required by a third of sick newborns. In addition, the linkages between obstetric and neonatal services need to be protected and strengthened. The Survive and Thrive report provides a list of in-patient interventions proven effective in preventing newborn mortality and disability, by each level of care; and WHO’s standards for quality care of small and sick newborns in facilities specify the various aspects of the health systems that need to be improved. Core interventions that should be available to all small or sick newborns beyond basic essential care for all newborns include:

1. Kangaroo Mother Care started as soon as possible after birth for small newborns, provided as continuously as possible for at least 20 hours per day during the time the newborn is transitioning and receiving neonatal special care;
2. Immediate and exclusive breastfeeding, including colostrum,  provided by cup, spoon, or NG tube if baby is unable to breastfeed;
3. Respiratory support when needed, guaranteeing safe oxygen use through blended air-oxygen and with oxygen saturation monitoring;
4. CPAP for respiratory distress requiring positive airway pressure with guarantees of safe oxygen use and oxygen saturation monitoring;
5. Appropriate and timely management of suspected serious infections (eg, sepsis, pneumonia, meningitis) with antibiotics and supportive care as needed;
6. Family-centered care with families having continuous access to their babies in special care or neonatal intensive care, and participating in providing appropriate care of their baby;
7. Developmentally supportive care for newborns and support for families to provide nurturing care in facilities and after discharge home;
8. Discharge planning with parents to ensure their competence and confidence to provide essential nurturing care at home; and
9. Follow up care after discharge from appropriate trained health care workers to monitor the baby’s condition, support the family for KMC and nurturing care, and referral for any new danger signs or complications (including Retinopathy of Prematurity follow up for small babies receiving oxygen therapy).

The WHO released recommendations for care of the preterm or low-birth-weight infant in 2022 detailing some of these core interventions.

(1,5)