Born Too Soon: Care for small and sick newborns, evidence for investment and implementation

Area of Science:

• Global health
• Neonatal care
• Public health policy

Background:

• Global policy progress for newborns, including Sustainable Development Goal (SDG) target 3.2 and the Every Newborn Action Plan (ENAP), has been made over the last decade.
• Significant gaps persist in investment and action for vulnerable newborns, particularly those born prematurely, underweight, or who become ill, with 20-30 million newborns annually requiring hospital care for life-threatening conditions.
• Approximately 2.3 million neonatal deaths occur annually, with the majority being preterm births, and an additional 1 million survivors face long-term disabilities.

Purpose of the Study:

• To highlight the urgent need for accelerated efforts to achieve SDG target 3.2 by 2030, requiring a four-fold increase in current progress.
• To emphasize the critical role of increased coverage and quality of high-impact newborn interventions, especially small and sick newborn care (SSNC), in preventing neonatal deaths and disabilities.
• To outline the ten core components of SSNC scale-up, emphasizing a health systems approach and the importance of family-centered care.

Main Methods:

• The study synthesizes global policy progress, identifies persistent gaps in newborn care, and analyzes the components required for scaling up small and sick newborn care (SSNC).
• It reviews evidence-based interventions, including respiratory support and kangaroo mother care, for preterm and sick newborns.
• The analysis incorporates a health systems approach, considering factors like political commitment, financing, human resources, infrastructure, data systems, referral networks, and family involvement.

Main Results:

• Achieving SDG 3.2 necessitates a four-fold acceleration in progress, with a shift towards facility-based births offering opportunities for improved maternal and newborn care.
• An evidence-based package for small and sick newborn care (SSNC) is identified as crucial for preventing most neonatal deaths and disabilities, particularly in preterm infants.
• Scaling up SSNC requires addressing ten core WHO/UNICEF-defined components, with specific attention to fragile and conflict-affected settings where newborn mortality is disproportionately high.

Conclusions:

• Ambitious investment in high-quality, family-centered care for vulnerable newborns yields a high return on investment (US$9-12 for every US$1 invested).
• Accelerating implementation requires multi-stakeholder collaboration, including political leaders, healthcare professionals, civil society, the private sector, families, and communities.
• Integrating newborn care into broader child and family systems is essential for ensuring newborns not only survive but also thrive, with a focus on capacity building in low- and middle-income countries.