The ethical, economic, and developmental imperative to prevent small vulnerable newborns and stillbirths: essential actions to improve the country and global response

Each year, 35 million newborns worldwide are born preterm (<37 weeks of gestation) or small-for-gestational age, and may be low birthweight (<2500 g). 1 Lawn JE Ohuma EO Bradley E et al. Small babies, big risks: global estimates of prevalence and mortality for vulnerable newborns to accelerate change and improve counting. Lancet. 2023; (published online May 8.)https://doi.org/10.1016/S0140-6736(23)00522-6 Summary Full Text Full Text PDF Scopus (2) Google Scholar These small vulnerable newborns (SVNs) have markedly reduced survival chances, with more than half (55·3%) of the 2·4 million neonatal deaths in 2020 attributed to being a SVN. 1 Lawn JE Ohuma EO Bradley E et al. Small babies, big risks: global estimates of prevalence and mortality for vulnerable newborns to accelerate change and improve counting. Lancet. 2023; (published online May 8.)https://doi.org/10.1016/S0140-6736(23)00522-6 Summary Full Text Full Text PDF Scopus (2) Google Scholar The survivors are vulnerable to health problems throughout their life course, including poor neurodevelopmental outcomes, low educational achievement, and increased risks of adulthood non-communicable diseases, such as hypertension, ischaemic heart disease, and stroke. 2 Ashorn P Ashorn U Muthiani Y et al. Small vulnerable newborns— big potential for impact. Lancet. 2023; (published online May 8.)https://doi.org/10.1016/S0140-6736(23)00354-9 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar Indeed, this effect is also intergenerational. For society, there are important human capital, economic, and productivity losses as well as costs such as health-care related costs. 2 Ashorn P Ashorn U Muthiani Y et al. Small vulnerable newborns— big potential for impact. Lancet. 2023; (published online May 8.)https://doi.org/10.1016/S0140-6736(23)00354-9 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar Small vulnerable newborns—big potential for impactDespite 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. Full-Text PDF Small babies, big risks: global estimates of prevalence and mortality for vulnerable newborns to accelerate change and improve countingSmall newborns are vulnerable to mortality and lifelong loss of human capital. Measures of vulnerability previously focused on liveborn low-birthweight (LBW) babies, yet LBW reduction targets are off-track. There are two pathways to LBW, preterm birth and fetal growth restriction (FGR), with the FGR pathway resulting in the baby being small for gestational age (SGA). Data on LBW babies are available from 158 (81%) of 194 WHO member states and the occupied Palestinian territory, including east Jerusalem, with 113 (58%) having national administrative data, whereas data on preterm births are available from 103 (53%) of 195 countries and areas, with only 64 (33%) providing national administrative data. Full-Text PDF Biological and pathological mechanisms leading to the birth of a small vulnerable newbornThe pathway to a thriving newborn begins before conception and continues in utero with a healthy placenta and the right balance of nutrients and growth factors that are timed and sequenced alongside hormonal suppression of labour until a mature infant is ready for birth. Optimal nutrition that includes adequate quantities of quality protein, energy, essential fats, and an extensive range of vitamins and minerals not only supports fetal growth but could also prevent preterm birth by supporting the immune system and alleviating oxidative stress. Full-Text PDF Evidence-based antenatal interventions to reduce the incidence of small vulnerable newborns and their associated poor outcomesA package of care for all pregnant women within eight scheduled antenatal care contacts is recommended by WHO. Some interventions for reducing and managing the outcomes for small vulnerable newborns (SVNs) exist within the WHO package and need to be more fully implemented, but additional effective measures are needed. We summarise evidence-based antenatal and intrapartum interventions (up to and including clamping the umbilical cord) to prevent vulnerable births or improve outcomes, informed by systematic reviews. Full-Text PDF