Postnatal interventions to support newborn survival: updates for the Lives Saved Tool.

Background: The period immediately after birth represents a highly vulnerable time for newborns, particularly in contexts without access to high-quality secondary care for small and/or sick newborns. Scaling up existing evidence-based interventions can avert much of the mortality and morbidity that occurs during the neonatal period. We summarise the evidence for interventions delivered postnatally and propose a set of effect estimates for inclusion in the Lives Saved Tool (LiST). Methods: We first conducted a set of systematic reviews and updates on the most recent evidence from randomised controlled trials on the effectiveness of interventions for reducing neonatal mortality and associated risk factors. We then assessed the evidence using standardised set of considerations alongside an iterative consultation process with newborn care experts to determine whether and how new meta-analysed effect estimates could be incorporated into the LiST model, as well as which of these estimates should be updated and which should be retained. Results: We proposed a new set of interventions that involve three packages of newborn care: a basic package (i.e. primary/community, secondary hospital care), a referral care package (i.e. tertiary care), and a package of promising innovative interventions whose evidence base is still developing. We included five new interventions within the updated LiST model's basic and referral packages: nasal continuous positive airway pressure coupled with preterm supportive care, newborn referral and transportation, animal-derived surfactant, prophylactic antifungals, and antibiotic stewardship. Three new interventions were proposed for the innovation package: magnesium sulphate for neuroprotection in asphyxiated newborns, topical emollient therapy, and probiotics/synbiotics for hospitalised preterm newborns. Conclusions: We synthesised the evidence base for the impact of a package of effective postnatal interventions for neonates for an updated LiST model. The new interventions and updated effect estimates can provide more accurate projections of potential impacts on neonatal survival for different intervention coverage scale-up scenarios in low- and middle-income countries.