As part of a supplement entitled "Born Too Soon", this paper focuses on care of the preterm newborn. An estimated 15 million babies are born preterm, and the survival gap between those born in high and low income countries is widening, with one million deaths a year due to direct complications of preterm birth, and around one million more where preterm birth is a risk factor, especially amongst those who are also growth restricted. Most premature babies (>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.DeclarationThis 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.

Kangaroo Mother Care is a beneficial intervention for high‐risk infants; however, global uptake is lacking. Recent systematic reviews have collated the numerous studies that identify diverse barriers and enablers to the use of Kangaroo Mother Care. In this narrative review, we combine the findings of these systematic reviews with more recent studies to propose a conceptual framework, encompassing factors that may affect the initiation and maintenance of Kangaroo Mother Care in neonatal units. Conclusion This conceptual framework includes parental, healthcare professional, and healthcare system factors, and highlights the potential interplay between them. In line with this, we suggest strategies to improve the uptake of Kangaroo Mother Care in neonatal units.

Objective: Providing quality health care is what all health facilities seek to achieve. Accreditation of health services are used to assess and improve the quality of health care in different settings. This study describes experiences of developing and conducting accreditation for excellence in newborn care in district hospitals in KwaZulu-Natal (KZN), South Africa following a 3-year programme of support to all nurseries in KZN. Methods: A facility review was conducted in district hospitals in KZN to evaluate the quality of care provided to newborn babies to accredit hospitals in newborn care. Multiple tools were used to assess different components of care from different perspectives, including record reviews, assessment of staff skills and interviews with mothers. Awarding accreditation was based on scores achieved in various domains, which contributed to an overall score. Compliance with key priority indicators was required for accreditation to be awarded. Results: Overall scores for accreditation ranged between 57%-93%. Mothers reported high levels of satisfaction with care received. Record reviews identified shortfalls in care provided, and skills assessments showed poor resuscitation skills in labour wards in some hospitals. Of 39 district hospitals, eight were awarded silver and five were awarded gold accreditation status. Conclusions: This accreditation of newborn care provides a workable model for undertaking accreditation in district hospitals and can be used by managers to identify and address shortfalls in care. Regular accreditation would support ongoing quality improvement (QI) in neonatal care and such a process could be applied to other aspects of care in health facilities.

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