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

Over the past decade, the world has made policy progress for newborns including the first global Sustainable Development Goal (SDG) target 3.2 (< 12 neonatal deaths per 1000 live births) and the Every Newborn Action Plan (ENAP). However, gaps remain for investment and action, especially for babies born too soon, too small, or who become sick. An estimated 20–30 million newborns have life-threatening conditions requiring hospital care each year. Annually, approximately 2.3 million newborns die during the neonatal period, the majority being preterm. A further 1 million newborn survivors are estimated to have long-term disabilities. To achieve SDG 3.2 by 2030, we need to accelerate four-fold. The shift to 80% of births in health facilities creates opportunities for impact, for both maternal and newborn care. Increased coverage and quality of high-impact newborn interventions is urgently needed to reach SDG targets. Most neonatal deaths and disabilities are preventable through an evidence-based package for small and sick newborn care (SSNC), with greatest impact seen in preterm babies—particularly through respiratory support and kangaroo mother care—while placing families at the centre of care. SSNC scale-up requires addressing ten core components, defined by WHO/UNICEF, based on a health systems approach: political commitment and leadership; financing; human resources; appropriate infrastructure; equipment and commodities; robust data systems and use of data for action; referral systems; linkage with high-quality maternal care; family and community involvement; and post-discharge follow-up. Specific focus is required for fragile conflict settings, accounting for 25% global births but 39% global newborn deaths. More ambitious investment in high-quality, family-centred care for vulnerable newborns can give a high return of between US$9−12 for every US$ 1 invested. Accelerating implementation requires diverse stakeholders, including political leaders, bureaucratic and technical leadership in country, professional societies, civil society, the private sector and importantly from families and communities. Cross-country collaboration and strengthening capacities of low- and middle-income countries to address gaps in newborn care are essential for innovations to reach high-burden, conflict-affected, and marginalised populations. Integrating newborn care follow-up into wider child and family care systems is crucial to ensure newborns not only survive but also thrive. In the last decade, policies for newborns have moved forward, but there are major gaps in action, especially for babies born too soon and others with complications. Every year, tens of millions of newborns face life-threatening conditions, especially for those who are preterm, or born too soon. Around 2.3 million newborns die in the first 28 days, with prematurity as the main cause. Another million survive with long-term disabilities. To meet targets, notably the Sustainable Development Goal 3.2 (under 12 neonatal deaths per 1,000 live births) and the Every Newborn Action Plan, there’s an urgent need to improve newborn care. The shift of births to health facilities (now 80%) provides a new opportunity for saving more lives. Most neonatal deaths can be avoided through small and sick newborn care which requires ten core health system components: political leadership, funding, trained staff, infrastructure, medical supplies, reliable data systems, referral networks, maternal care integration, family involvement, and follow-up after discharge. More investment is needed to ensure all newborns have access to high-quality care, including those in conflict zones or marginalised groups. Over the next decade, countries can go faster and learn together to innovate and improve for newborn care. Ensuring follow-up care for developmental outcomes is foundational for newborns to reach their full potential. • Over the past decade, the world has set new policy targets for newborn survival, including the first ever globally agreed neonatal survival target but gaps remain for investment and programmatic action, especially for babies born too soon, too small, or who become sick. • Globally, the place where babies receive care has shifted, with >80% of births now occurring in health facilities. • An estimated 20-30 million small and sick newborns have life-threatening conditions that require inpatient care in hospitals each year, half of whom are preterm. • Quality improvement and availability of inpatient newborn care is urgently needed now to reach SDG target 3.2 (<12 deaths per 1000 live births) and Every Newborn Action Plan targets. • Most major causes of neonatal death can be prevented by adopting a health systems approach to the scaling up of small and sick newborn care (SSNC) in countries. This requires ten core components: political commitment and leadership; financing; human resources; appropriate infrastructure; equipment and commodities; robust data systems and use of data for action; referral systems; linkage with high-quality maternal care; family and community involvement; and post-discharge follow-up systems. • Invest more ambitiously in SSNC to ensure equitable universal access to high-quality, family-centred services, including in areas of conflict and for marginalised populations. • Implement high-quality, family-centred care with widespread involvement and support from families, communities, professional societies, politicians and business communities. • Innovate through multi-country learning, including sharing of existing tools and development/improvement of technologies and systems for SSNC in all contexts, especially high-burden settings. • Integrate family-centred care and follow-up for developmental outcomes into existent systems newborn, linking with maternal care, to ensure that the newborns who survive also thrive.