More than half of neonatal deaths are attributable to being born too soon or small; these infants are known as small vulnerable newborns. Global estimates for 2020 suggest that 23.4 million neonates were born small for gestational age, 13.4 million were preterm, and 19.8 million had low birthweight. There are several reasons for babies being born small or early; high rates of protein and micronutrient deficiencies in pregnant people are some of the key factors. Small vulnerable newborns are at elevated risk of mortality, growth and cognitive faltering, and non-communicable diseases in later life. In The Lancet Global Health, Dongqing Wang and colleagues used an individual patient data meta-analysis to assess the effect of multiple micronutrient supplements (MMSs) and small-quantity lipid nutrient supplements (SQ-LNSs) on the ten different categories within the small vulnerable newborn group. This is a very timely publication as it reinvigorates the debate for revisiting the guidelines for antenatal supplementation, especially considering the long overdue debate to replace routine iron and folic acid with MMSs.
