At-Risk Newborns: Overlooked in Expansion From Essential Newborn Care to Small and Sick Newborn Care in Low- and Middle-Income Countries

Figures & Tables

TABLE.

Recommendations for Level of Facility Care for the 3 Categories of Newborns

	Well Newborns	At-Risk Newborns	Small and Sick Newborns
Location/placement	Postnatal ward/postpartum unit (wards or single rooms)	Roomed-in with mothers in a designated areaAttached to/in the postnatal ward/postpartum unitAttached to SNCU/NICU^aKangaroo mother care units	Special neonatal care unit/neonatal intensive care unitMother-baby unit ^b
Health care provider	Midwives/nurses well trained in the basic care of both the mother and baby, preparation for discharge, and monitoring for and identification of danger signsIdeally and where feasible, coupled with daily rounding by trained physician assistants, nurse practitioners, physicians, pediatricians, and/or neonatologists	Midwives/nurses trained additionally in the monitoring and care of the at-risk babiesDaily rounding by trained physician assistants, physicians, pediatricians, and/or neonatologists with additional visits as required (more frequent than for well babies)	Nurses trained to provide level II, III, and IV care^cPediatricians, neonatologists, and/or midlevel providers trained to provide level II, III, and IV care

↵a Typically, special neonatal care units/neonatal intensive care units do not support rooming-in care for the postpartum mother.
↵b Neonatal units, often level II, where small and sick newborns are kept with their mothers, separate from the general postnatal wards/postpartum units (as in some sub-Saharan countries).
↵c Level 1 care: resuscitation at delivery and postnatal care to stable term and late preterm infants (35–<37 weeks of gestation) and stabilization and transport to all others; level II care: >32 weeks of gestation and >1500 g, or moderately ill with conditions expected to resolve rapidly; level III/IV: provide sustained life support and comprehensive care including access to pediatric subspecialists (American Academy of Pediatrics Committee of Fetus and Newborn).²⁶