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Updated: Jul 30, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Small vulnerable newborns-big potential for impact
Per Ashorn1, Ulla Ashorn2, Yvonne Muthiani2
1Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
Insights
Preventing small vulnerable newborns (SVN), defined as preterm, small for gestational age, or low birthweight infants, is crucial for reducing neonatal mortality and improving child survival globally. A unified definition and framework can enhance prevention strategies and outcomes.
Area of Science:
- Neonatal health
- Global child survival
- Public health policy
Background:
- Neonatal mortality remains high globally, with preterm birth, small for gestational age (SGA), and low birthweight (LBW) being primary causes.
- These conditions contribute to stillbirths, infant morbidities, and long-term adverse consequences, impacting human capital and societal development.
- Slow progress in prevention is attributed to a lack of consensus on definitions, problem framing, and governance structures.
Purpose of the Study:
- To propose a new definition and conceptual framework for newborn vulnerability.
- To unify preterm birth, SGA, and LBW under the umbrella term 'small vulnerable newborn' (SVN).
- To facilitate improved problem definition and programming for SVN prevention.
Main Methods:
- Conceptual framework development.
- Literature review on neonatal mortality and vulnerability factors.
- Proposal of a unified definition for SVN.
Main Results:
- A new conceptual framework and definition for the 'small vulnerable newborn' (SVN) are proposed.
- This unified approach aims to consolidate efforts in addressing preterm birth, SGA, and LBW.
- The framework is expected to improve problem definition and programming for SVN prevention.
Conclusions:
- Adopting the SVN framework and definition can enhance global efforts to prevent neonatal mortality and morbidity.
- Effective SVN prevention strategies will lead to healthier infant starts, reduced stillbirths, improved maternal health, and positive socioeconomic development.
- A unified approach is critical for building a broad coalition and effective governance for change in neonatal care.
Abstract:
Despite major achievements in child survival, the burden of neonatal mortality has remained high and even increased in some countries since 1990. Currently, most neonatal deaths are attributable to being born preterm, small for gestational age (SGA), or with low birthweight (LBW). Besides neonatal mortality, these conditions are associated with stillbirth and multiple morbidities, with short-term and long-term adverse consequences for the newborn, their families, and society, resulting in a major loss of human capital. Prevention of preterm birth, SGA, and LBW is thus critical for global child health and broader societal development. Progress has, however, been slow, largely because of the global community's failure to agree on the definition and magnitude of newborn vulnerability and best ways to address it, to frame the problem attractively, and to build a broad coalition of actors and a suitable governance structure to implement a change. We propose a new definition and a conceptual framework, bringing preterm birth, SGA, and LBW together under a broader umbrella term of the small vulnerable newborn (SVN). Adoption of the framework and the unified definition can facilitate improved problem definition and improved programming for SVN prevention. Interventions aiming at SVN prevention would result in a healthier start for live-born infants, while also reducing the number of stillbirths, improving maternal health, and contributing to a positive economic and social development in the society.
