80%) are between 32 and 37 weeks of gestation, and many die needlessly for lack of simple care. We outline a series of packages of care that build on essential care for every newborn comprising support for immediate and exclusive breastfeeding, thermal care, and hygienic cord and skin care. For babies who do not breathe at birth, rapid neonatal resuscitation is crucial. Extra care for small babies, including Kangaroo Mother Care, and feeding support, can halve mortality in babies weighing <2000 g. Case management of newborns with signs of infection, safe oxygen management and supportive care for those with respiratory complications, and care for those with significant jaundice are all critical, and are especially dependent on competent nursing care. Neonatal intensive care units in high income settings are de-intensifying care, for example increasing use of continuous positive airway pressure (CPAP) and this makes comprehensive preterm care more transferable. For health systems in low and middle income settings with increasing facility births, district hospitals are the key frontier for improving obstetric and neonatal care, and some large scale programmes now include specific newborn care strategies. However there are still around 50 million births outside facilities, hence home visits for mothers and newborns, as well as women's groups are crucial for reaching these families, often the poorest. A fundamental challenge is improving programmatic tracking data for coverage and quality, and measuring disability-free survival. The power of parent's voices has been important in high-income countries in bringing attention to preterm newborns, but is still missing from the most affected countries. Declaration This article is part of a supplement jointly funded by Save the Children's Saving Newborn Lives programme through a grant from The Bill & Melinda Gates Foundation and March of Dimes Foundation and published in collaboration with the Partnership for Maternal, Newborn and Child Health and the World Health Organization (WHO). The original article was published in PDF format in the WHO Report "Born Too Soon: the global action report on preterm birth" (ISBN 978 92 4 150343 30), which involved collaboration from more than 50 organizations. The article has been reformatted for journal publication and has undergone peer review according to Reproductive Health's standard process for supplements and may feature some variations in content when compared to the original report. This co-publication makes the article available to the community in a full-text format."/>
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Table 1 Life-saving essential and extra newborn care.

From: Born Too Soon: Care for the preterm baby

Risk for all babies, especially those who are preterm Essential care for all babies Extra care for preterm babies
Hypothermia = low body temperature (increased risk of infections, mortality and for preterm babies increased risk of RDS) Thermal care
Drying, warming, skin-to-skin and delayed bathing
Extra thermal care
Kangaroo Mother Care, baby hats, blankets, overhead heaters, incubators
Cord and skin infections, neonatal sepsis Hygienic cord and skin care at birth and home care practices
Hand washing and other hygiene
Delayed cord clamping
Consider chlorohexifine
Extra attention to infection prevention and skin care
Consider chlorohexidine and emolients
Hypoglycemia = low blood sugar
(Increased risk of impairment or death)
Early and exclusive breastfeeding Extra support for breastfeeding
e.g. expressing and cup or tube feeding, supplemented breast milk if indication Lack of breast milk is a risk factor for necrotizing entereocolitis in preterm babies
Hypoxia = low oxygen levels
(Increased risk of impairment or death for preterm babies, higher risk of RDS and intracranial bleeding)
Neonatal resuscitation if not breathing at birth
Bag-and-mask resuscitation with room air is sufficient for >99% of babies not breathing at birth
Safe oxygen use
Monitored oxygen use e.g. in head box or with nasal cannula, routine use of pulse oximeters
  1. Source: : Born Too Soon, Chapter 5 [113].