Supportive Care for Common Conditions in Small Vulnerable Newborns and Term Infants: The Evidence

Introduction: Small vulnerable newborns (SVNs) are at an increased risk of early death and other morbidities. Essential interventions provided to SVN, and other high-risk new?borns have been proven critical in improving their out?comes. We aimed to provide an update on the effectiveness and safety of these interventions in low- and middle-income countries (LMICs). Method: Following a comprehensive lit?erature scope, we updated or reanalyzed LMIC-specific evidence for essential SVN care interventions. Results: A total of 113 individual LMIC studies were identified. Most of them were of high risk of bias. Kangaroo mother care sig?nificantly reduced SVN s mortality by discharge. Early erythropoiesis stimulating agent lowered SVN s risk of re?ceiving blood transfusion. Prophylactic oral or intravenous ibuprofen resulted in a decreased risk of patent ductus arteriosus in SVN. But it did not have a significant effect on mortality and led to a higher risk of gastrointestinal bleeding. No pooled LMIC data were available for universal screening of hyperbilirubinemia in high-risk newborns. Sunlight therapy had no effect in treating hyper?bilirubinemia but increased the risk of hyperthermia. Re- flective curtains with phototherapy resulted in a greater and faster decline in bilirubin than standard phototherapy in treating hyperbilirubinemia. Early child development in?terventions were shown to have a favorable effect on cognitive and motor scores in SVN. The evidence for family involvement and family support was limited and uncertain. Conclusion: We present the most updated LMIC evidence for interventions targeting SVN. Despite their effectiveness and safety in improving certain neonatal outcomes, further high-quality trials are required. 2024 The Author(s). Published by S. Karger AG, Basel.