TY - JOUR T1 - At-Risk Newborns: Overlooked in Expansion From Essential Newborn Care to Small and Sick Newborn Care in Low- and Middle-Income Countries JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-22-00099 VL - 11 IS - 1 SP - e2200099 AU - Indira Narayanan AU - James A. Litch AU - Ganga L. Srinivas AU - Kwabena Onwona-Agyeman AU - Alhassan Abdul-Mumin AU - Jayashree Ramasethu Y1 - 2023/02/28 UR - http://www.ghspjournal.org/content/11/1/e2200099.abstract N2 - Key MessagesIn global health, the initial focus on essential newborn care for all now includes adding specialized care for small and sick newborns.In many low- and middle-income countries (LMICs), this has resulted in transferring relatively stable newborns with risk factors who require observation and minimal support to special/intensive care units that are already overcrowded and understaffed.To prevent needless separation from mothers and overcrowding in neonatal units, we propose an “at-risk” category of newborns and suggest feasible, more cost-effective options to manage these newborns at health care facilities in LMICs.Between 1990 and 2017, the global under-5 mortality rate declined by 58% and the neonatal mortality rate by 51%,1 but both measures remain well above the Sustainable Development Goal targets for 2030.2 In many low- and middle-income countries (LMICs), major challenges persist, hindering the achievement of Sustainable Development Goal 3.2, in particular, of reducing preventable deaths of newborns to at least 12 deaths per 1,000 live births by the year 2030.2Newborn care in LMICs has varied based on factors such as the low availability of funds and the competing priorities of country governments, various stakeholders, and the private sector. Newborn care was initially viewed as a high-tech intervention, and resources were consequently focused on level III neonatal intensive care units (NICUs) and level II special neonatal care units (SNCUs) in hospitals, even when home deliveries were common. Community-based newborn care was positioned under the larger umbrella of maternal and child health, with the newborn components often slipping between the 2 pillars of maternal health and child health.Over the last 2 decades, a more coordinated attempt to address newborn care has been implemented in LMICs through programs such as Basic Support for Institutionalization of Child Survival (BASICS),3 Maternal and Newborn Health Program,4 Saving Newborn … ER -