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

Progress: 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.

Programmatic priorities: 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.

Pivots: 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.