Neonatal Health Outcomes Research Articles

Pooled prevalence and factors of low birth weight among newborns in the top 20 countries with the highest infant mortality: analysis of recent demographic and health surveys

ObjectiveThis study aimed to assess the pooled prevalence and factors of low birth weight among newborns in the top 20 countries with the highest infant mortality rates.DesignWe conducted a community-based...

Maternal social determinants of health: the hidden face of perinatal mortality in Mexico

BackgroundPerinatal mortality, encompassing late stillbirths and neonatal mortalities, is a key indicator of maternal and neonatal health. Despite advances in health care, there have been alarming increased in perinatal mortality rates in Mexico. This study investigated the influence of social determinants on perinatal death in a Latin American middle-income country, aiming to inform equitable and effective health policies.MethodsA prospective cohort study was conducted with pregnant women from Mexico City. Data on the following clinical and social factors were collected: pregestational body mass index (pBMI), lupus, antiphospholipid syndrome (APS), preeclampsia, foetal growth restriction (FGR), social vulnerability, poverty, household overcrowding, and gender-based violence. Nested logistic regression models were developed to identify significant predictors of perinatal mortality, with the results reported as odds ratios (ORs) and 95% confidence intervals (CIs).ResultsAmong the 3,890 participants, there were 76 cases of perinatal mortality. Significant clinical predictors of perinatal mortality included higher pBMI (OR = 1.088, 95% CI 1.026–1.153), APS (OR = 10.049, 95% CI 1.843–54.803), and FGR (OR = 2.929, 95% CI 1.399–6.135), whereas high social vulnerability (OR = 5.332, 95% CI 2.485–11.443) and medium social vulnerability (OR = 3.084, 95% CI 1.528–6.222) emerged as significant social predictors of perinatal mortality. A comprehensive model incorporating both clinical and social determinants achieved an AUC of 0.921, with a detection rate of 67.1% and a false-positive rate of 10%, this indicating a significant improvement in perinatal mortality prediction. The inclusion of social determinants progressively enhanced predictive performance, underscoring their critical role in risk assessment.ConclusionsClinical and social determinants significantly influence perinatal mortality. Addressing social inequalities and integrating social determinants into perinatal care could improve maternal and neonatal health outcomes. However, limitations such as reliance on self-reported data, ecological-level indicators for social vulnerability, and potential constraints on generalizability should be considered. These findings emphasize the need for targeted health policies to reduce social vulnerabilities and enhance health care access in middle-income countries.

Reducing Neonatal Mortality in Nepal’s Remote Regions: A Narrative Review of Challenges, Disparities, and the Role of Helping Babies Breathe (HBB)

Background: Nepal’s diverse geography creates significant challenges for healthcare accessibility, particularly for neonatal care. Rural areas, especially in the mountainous regions, face severe healthcare gaps due to isolation, inadequate infrastructure, and a shortage of skilled staff. Strengthening healthcare in these underserved regions is essential to reducing neonatal mortality. Helping Babies Breathe (HBB) is a neonatal resuscitation training program designed to reduce neonatal mortality due to birth asphyxia in low-resource settings. Methods: A comprehensive literature search identified studies on neonatal mortality and interventions, particularly HBB, which were analyzed using a narrative synthesis approach. This review examines disparities in neonatal health outcomes, regional differences, and barriers to healthcare access. Findings: This review identifies key themes related to healthcare disparities, neonatal mortality, and birth outcomes in Nepal’s remote regions. Geographical isolation, inadequate healthcare infrastructure, and cultural barriers contribute to persistently high neonatal mortality, particularly in mountainous areas such as Jumla and Dolpa, where rates exceed 60 per 1000 live births. HBB has shown a significant impact, reducing neonatal mortality by up to 60% when effectively implemented. However, infrastructural gaps, lack of emergency transport, and the uneven distribution of skilled birth attendants (SBAs) remain critical challenges. Addressing these disparities requires expanded training, increased availability of neonatal resuscitation equipment, and culturally sensitive healthcare strategies.

HTLV-1 and Pregnancy: A Retrospective Study of Maternal and Neonatal Health Outcomes in an Endemic Region of Brazil

Human T-cell lymphotropic virus type 1 (HTLV-1) infection poses significant challenges to maternal and neonatal health, particularly in endemic regions. Vertical transmission, which occurs most commonly through prolonged breastfeeding and rarely during pregnancy, or childbirth, perpetuates the virus within families. This observational, retrospective study analyzed HTLV-1-infected and uninfected pregnant women admitted for delivery at a university maternity hospital in Salvador, Brazil (2020–2022). Medical records provided sociodemographic, clinical, and laboratory data. The HTLV-1 infection rate was 4.61 per 1000 deliveries. The sociodemographic characteristics were similar between infected (n = 17) and uninfected (n = 34) women. HTLV-1-positive women had higher rates of unplanned and undesired pregnancies. Adverse pregnancy outcomes were frequent in both groups (94.1% vs. 91.2%), but metabolic disorders and hypertension/eclampsia were more common among the infected women. Preterm birth and postpartum complications were also more frequent (17.6% vs. 5.9%, respectively), although the difference was not statistically significant. Breastfeeding initiation within the first hours of life was lower among exposed newborns (28.6% vs. 70%; p = 0.013). Neonatal characteristics did not differ significantly between the groups. These findings highlight critical gaps in reproductive health awareness and barriers to accessing preventive interventions. Further research on therapeutic strategies is urgently needed to support the World Health Organization’s (WHO) goal of eliminating HTLV-1 vertical transmission by 2030.

Experiences and Challenges of Rural Nurses in Botswana Handling Births Outside the Hospital Environment.

This study aims to explore the experiences and challenges faced by rural nurses in Botswana who manage births outside the hospital environment, providing insights into the impact of these experiences on maternal and neonatal health outcomes. A qualitative descriptive design was employed to gain a comprehensive understanding of the participants' perspectives and experiences. Twenty-six registered nurses from four remote health districts in Botswana were selected using a purposive convenience sampling technique. Semi-structured interviews were conducted to gather in-depth data regarding their experiences managing childbirth in rural settings. The analysis revealed that nurses face significant emotional and practical challenges, including feeling unprepared for emergencies, lack of access to resources, and high levels of stress associated with managing complications without specialized training. Many participants reported a strong commitment to their communities despite the hurdles, underscoring their vital roles in maternal healthcare. The findings indicate a pressing need for enhanced training programs and support systems for rural nurses to better equip them for the complexities of childbirth management outside hospital settings. Addressing these gaps is essential to improve clinical outcomes for mothers and infants and to minimize the risks associated with unsupervised births. This study highlights the crucial role rural nurses play in maternal health and stresses the need for targeted training and policy interventions. By strengthening the capacity of these healthcare providers, we can work toward reducing maternal and neonatal morbidity and mortality rates in Botswana and similar rural settings worldwide.

Factors influencing early initiation of breastfeeding in Afghanistan: secondary analysis of the Afghanistan MICS 2022–23

BackgroundInitiating breastfeeding immediately within the first hour following birth has positive effects on the mother’s and newborn’s health and wellbeing. Little is known about the early initiation of breastfeeding and associated factors in Afghanistan. In this study, we addressed this research gap.MethodsWe used data from the Afghanistan Multiple Indicator Cluster Survey (MICS) 2022–23. Data were analysed from 11,992 ever-married women, aged 15–49 years, who delivered a live child in the last 2 years before the survey. The outcome was early initiation of breastfeeding and defined as initiating breastfeeding within the first hour of birth. A logistic regression model was used to identify factors associated with early initiation of breastfeeding.ResultsOut of 11,992 women, 46.9% initiated breastfeeding within the first hour of birth. The likelihood of early initiation of breastfeeding was greater in women with secondary or higher education (AOR 1.44 [95% CI 1.26, 1.63]), in women belonging to the second wealth quintile (AOR 1.17 [95% CI 1.04, 1.31]), in women who had access to media (AOR 1.15 [95% CI 1.03, 1.29]), and in women who had mobile phones (AOR 1.25 [95% CI 1.15, 1.37]). The likelihood was lower in women who gave birth at home (AOR 0.60 [95% CI 0.55, 0.66]), at private hospitals or clinics (AOR 0.65 [95% CI 0.56, 0.76]), as compared to women who gave birth at public clinics or hospitals, and in women living in rural areas (AOR 0.88 [95% CI 0.78, 0.95]). Women who had C-section for their latest live birth (AOR 0.26 [95% CI 0.21, 0.32]), and women who had very small-sized babies (AOR 0.89 [95% CI 0.79, 0.99]) were less likely to report early initiation of breastfeeding.ConclusionWith nearly half of Afghan women delaying breastfeeding beyond the first hour of birth, targeted health policies and interventions are crucial. Addressing key socioeconomic and healthcare disparities through education, equitable access to maternal care, and community-based awareness programs can promote early breastfeeding practices and improve neonatal health outcomes in Afghanistan.

Micronutrient Deficiencies in Pregnancy: Bridging Gaps between Global Guidelines and Community Practices

Background: Micronutrient deficiencies (MNDs) during pregnancy, including deficiencies in iron, folate, vitamin D, iodine, and zinc, remain a critical public health challenge, particularly in low- and middle-income countries (LMICs). Despite the availability of international guidelines from organizations such as the World Health Organization (WHO) and UNICEF, the implementation of these guidelines at the community level remains inconsistent, leading to persistent gaps in maternal and neonatal health outcomes.  Aim: This review aims to explore the disparities between international guidelines and their actual implementation in community settings, identify barriers to effective micronutrient supplementation, and propose sustainable, culturally sensitive solutions to address these gaps.  Methods: A comprehensive narrative review of 150 peer-reviewed articles published between 2013 and 2024 was conducted. Databases such as PubMed, Cochrane, and Scopus were searched, and national health surveys were reviewed to provide a global perspective. The PRISMA guidelines and CASP checklists were employed to ensure methodological rigor.  Results: The review identified several key challenges, including variable coverage of micronutrient supplementation (30–70% in LMICs), cultural myths, logistical issues, and supply chain inefficiencies. Effective strategies to address these challenges include food fortification, community education, digital health interventions, and innovative technological tools.  Conclusion: Addressing micronutrient deficiencies in pregnancy requires a multisectoral approach that integrates health system strengthening, culturally sensitive interventions, and robust supply chain mechanisms. Policymakers must prioritize maternal nutrition within universal health coverage (UHC) frameworks to ensure sustainable improvements in maternal and neonatal health outcomes.

Maternal Vitamin A Deficiency in Pregnancy and its Relationship with Maternal and Neonatal Haemoglobin Concentration

Vitamin A Deficiency (VAD) remains a major nutritional concern, particularly in low-income countries, and is associated with maternal anemia and adverse neonatal outcomes. Objective: To assesses the correlation between maternal Vitamin A levels and hemoglobin concentrations in both mothers and neonates along with its impact on neonatal health outcomes. Methods: A cross-sectional study was conducted at Khyber medical university (Hayatabad Medical Complex, Peshawar), over one year. Pregnant women in their third trimester were recruited based on predefined eligibility criteria. Serum Vitamin A levels were measured using high-performance liquid chromatography (HPLC), and hemoglobin levels were assessed in both maternal and neonatal blood samples. Statistical analyses included t-tests, chi-square tests, and binary logistic regression. Results: Among 121 participants, 84% were Vitamin A deficient (<0.70 µmol/L). Maternal hemoglobin was significantly lower in the deficient group (10.38 g/dL vs. 11.83 g/dL, p = 0.001), as was neonatal hemoglobin (13.40 g/dL vs. 14.31 g/dL, p = 0.001). Low birth weight was more common in the deficient group (31.0% vs. 10.8%), though not statistically significant after Bonferroni correction. Logistic regression confirmed Vitamin A deficiency as an independent predictor of low neonatal hemoglobin (AOR = 3.174, p = 0.043). Conclusions: Vitamin A deficiency is significantly associated with lower maternal and neonatal hemoglobin levels. These findings highlight the importance of maternal nutrition interventions to prevent anemia-related complications.

Effect of Maternal Nutrition and Micronutrient Supplementation on Neonatal Birth Weight and Health

Maternal nutrition significantly influences fetal growth, birth weight, and neonatal health. Deficiencies in iron, calcium, folic acid, and vitamin D increase the risks of preterm birth, low birth weight, and neonatal complications. Objective: To assess the impact of maternal micronutrient supplementation on neonatal birth weight and health outcomes. Methods: A quasi experimental study was conducted at Health Net Hospital, Peshawar. A total of 110 pregnant women were recruited (59 supplemented, 51 non-supplemented). Data on maternal dietary intake, weight gain, and micronutrient consumption were collected. Neonatal birth weight, gestational age, NICU admissions, and morbidity were recorded. Statistical analysis was performed using SPSS version 25.0, with independent t-tests and chi-square tests (p<0.05 considered significant). Results: Neonates in the supplemented group had significantly higher birth weights (3343.54 ± 407.90 g vs. 2825.63 ± 322.46 g, p<0.001). NICU admissions were lower in the supplemented group (6.8% vs. 43.1%, p<0.001). Neonatal morbidity, including infections, jaundice, and respiratory distress, was significantly lower in the supplemented group (p<0.001). Conclusions: Micronutrient supplementation during pregnancy improves neonatal birth weight and reduces neonatal morbidity. These findings highlight the need for targeted maternal nutrition strategies to improve neonatal outcomes, particularly in resource-limited settings.

Analysing Continuity of Care Implementation in the Midwifery-Led Care Model in Malang Regency

This study aims to explore the implementation of Continuity of Care (CoC) within the Midwifery Led Care (MLC) model in Malang Regency. The maternal and child health indicators remain a concern due to high maternal mortality rates, exacerbated by complications such as preeclampsia and hemorrhage. CoC has been recognized for its ability to improve maternal and neonatal health outcomes by providing consistent care through midwives. This qualitative research, using a phenomenological approach, involved in-depth interviews with 20 mothers (10 primipara, 10 multipara) who experienced MLC, supported by observations and secondary data. Results revealed that both primipara and multipara mothers valued continuous midwifery care, though their experiences varied based on parity. Primipara mothers generally required more information and support, while multipara mothers exhibited greater confidence in midwife-led care. Barriers such as limited access to health services in remote areas, a lack of trained midwives, and insufficient community education on the benefits of MLC were identified. Recommendations include enhancing midwife training, improving access to healthcare in rural regions, and increasing public awareness of CoC benefits. The findings emphasize the importance of expanding MLC and CoC models to reduce maternal and neonatal morbidity and mortality in underserved areas.

Upgrading delivery rooms in Africa's primary healthcare systems: a combination strategy of the 'staff, stuff, space, and systems' framework and emerging technologies.

Maternal health disparities in sub-Saharan Africa remain critical, with high maternal mortality ratio requiring urgent interventions. In this viewpoint, we propose an integrated strategy combining the 'staff, stuff, space, and systems' (4S) framework with emerging technologies to upgrade delivery rooms in primary health care settings. Infrastructure enhancements, point-of-care innovations like artificial intelligence-driven diagnostics and ultrasound, and workforce training through traditional training-of-trainers approach or emerging simulation-based education aim to improve maternal and neonatal health outcomes. While financial and systemic barriers persist, sustainable funding, community engagement, and policy support are crucial for success. The integrated strategy offers a scalable solution to reduce maternal mortality and advance the maternal and child health targets of the 2030 Sustainable Development Goals.

Human placental models for studying viral infections.

Viral infections during pregnancy represent a major threat to maternal, fetal, and neonatal health outcome, with a high risk of vertical transmission. It is therefore crucial to understand the mechanisms underlying the interaction between viruses and placenta, which ensures communication between maternal and fetal compartments throughout pregnancy. Human placental models, both in vitro and ex vivo, enable to dissect in detail these interactions. By studying in detail viral entry, replication, and immune responses within the placenta, they represent ideal tools for analyzing the effects of various viruses on pregnancy outcomes. In addition, these models serve as platforms for evaluating diagnostic and therapeutic approaches to protect pregnant women and their babies from viral infections. This review examines recent advances, the main advantages and limitations of different human placental models and discusses their potential to improve our understanding of virus-placenta interactions, thereby contributing to improved maternal and fetal health.

Comparison of statistical modelling methods for population-level gestational weight gain trajectories in ethnically diverse women in southeast Melbourne, Australia

ObjectivesAdverse lifestyle promotes escalating excess gestational weight gain (GWG) driving poor maternal and neonatal health outcomes. Recommended pregnancy lifestyle interventions rely on accurate assessment and prediction of GWG. A modelling...

The impact of interactive text communication on neonatal mortality in Kenya: a randomized controlled trial.

Text communication between newborns' caregivers and healthcare workers allows for real-time decisional guidance; however, its impact on neonatal health outcomes is unknown. Mobile WACh NEO (MWACh NEO) was a parallel, unblinded and individually randomized controlled trial at six health facilities across Kenya. Pregnant women at 28-36 weeks gestation were randomized (1:1) to the MWACh NEO intervention or standard of care. MWACh NEO delivered automated maternal and neonatal health text messages to participants up to 6 weeks postpartum and allowed free text communication with a nurse. This trial sought to determine if text communication decreased neonatal mortality. The analysis was intention to treat. From September 2020 until June 2022, 5,020 participants were enrolled and randomized. One hundred and thirty-six participants were excluded because of incomplete mortality data, leaving 2,442 participants in each group for the analysis. Eighty-three neonatal deaths occurred for a neonatal mortality rate of 18.8 per 1,000 live births in the intervention group and 15.2 per 1,000 live births in the control group, with a risk ratio of 1.25 (0.81, 1.91), P = 0.31. No adverse events related to the intervention were reported. Text communication did not decrease neonatal mortality compared to standard of care. Most neonates died before discharge from the facility. ClinicalTrials.gov registration: NCT04598165 .

Community Perceptions of Neonatal Infection in Uganda.

We investigated awareness of neonatal infections among a population of pregnant women and other community members in Kampala, Uganda. We explored perceived causes of neonatal infections and perceptions of appropriate treatments. We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) with 97 participants: 25 community leaders who took part in 3 FGDs, 12 pregnant women who took part in IDIs, and 60 pregnant women who took part in 8 FGDs, between November 2019 and October 2020. Data were analyzed thematically. This work formed part of the PROGRESS study, an observational cohort study undertaken in Kampala, Uganda, between November 2018 and April 2021. Beliefs about causes, signs, symptoms, and treatment of infants with suspected infections impacted health-seeking behavior. Some illnesses were perceived to be caused by environmental factors while others were believed to have social or behavioral causes, such as the promiscuity of the male partner causing infections or the mother being bewitched. Local herbs and traditional remedies were the most preferred method of treatment and were commonly relied on to address various health issues rather than conventional medicines. Notably, no participant mentioned vaccines as a way of preventing infections. Pregnant women and community members' understanding of the causes and treatment of neonatal illnesses were diverse, including environmental, social-behavioral, and supernatural causes, while both conventional and traditional remedies were perceived as appropriate treatments and sought accordingly. Understanding community perceptions and practices around neonatal infections is key to improving neonatal health interventions and outcomes.

Development and validation of a machine learning model for predicting intrapartum fever using pre-labor analgesia clinical indicators: a multicenter retrospective study.

Labor anesthesia is commonly used for pain relief during labor, but it can increase the risk of intrapartum fever. Currently, there are no reliable tools to predict which parturients might develop fever before labor anesthesia. The prediction model we developed aims to predict the incidence of intrapartum fever before labor analgesia. This study retrospectively analyzed the clinical data of parturients who underwent labor analgesia at Chengdu Jinjiang District Maternal & Child Health Hospital and Sichuan Jinxin Xinan Women's & Children's Hospital from January 2021 to June 2023. After the data were processed, the parturients were randomly divided into training and validation cohorts at an 8:2 ratio. The least absolute shrinkage and selection operator method was used for feature selection. Six machine learning models were developed and subjected to comprehensive analysis to assess and validate their predictive capabilities, ultimately selecting the best-performing model. The study included a total of 5,052 parturients, with 418 (8.27%) parturients experiencing intrapartum fever. The predictive factors were primiparity, estimated neonatal weight, degree of uterine dilatation, presence of anemia, number of vaginal examinations, and height. The multilayer perceptron model emerged as the best-performing predictive model, achieving an area under the curve of 0.707, a sensitivity of 0.753, and a specificity of 0.584. The multilayer perceptron model, utilizing readily available pre-labor analgesia variables, demonstrates potential for predicting intrapartum fever. In comparison to existing tools, this model may enable earlier identification of high-risk parturients, supporting timely interventions and potentially enhancing maternal and neonatal health outcomes.

The association between coronavirus disease 2019 vaccination during pregnancy and neonatal health outcomes.

Pregnant women have a higher risk of severe illness or complications due to a severeacuterespiratorysyndromecoronavirus2 infection. To reduce these risks, pregnant women are advised to coronavirusdisease 2019 (COVID-19) vaccination. Continued monitoring of the safety of maternal COVID-19 vaccination remains important. To evaluate the association between maternal COVID-19 vaccination and neonatal health. Data from the Dutch Pregnancy Drug Register were used. In this prospective cohort study, pregnant women self-reported COVID-19 vaccination and neonatal health outcomes. We included women with a due date between January 15, 2021, and May 15, 2022, and a singleton live birth after at least 24 weeks gestation. Using log-binomial regression analysis we studied the association between COVID-19 vaccination during pregnancy and the health outcomes; small for gestational age (SGA), large for gestational age (LGA), and neonatal health problems. We corrected for potential confounders using inverse probability of treatment weighting. In total, 3655 participants were included (92.1% COVID-19 vaccinated during pregnancy). Of all participants, 8.9% reported SGA, 11.1% reported LGA, and 16.4% reported neonatal health problems. Maternal COVID-19 vaccination was not statistically significantly associated with SGA (adjusted prevalence ratio [aPR]: 0.90; 95% confidence interval [CI]: 0.59-1.36), LGA (aPR: 1.07; 95% CI: 0.70-1.63), or neonatal health problems (aPR: 0.84; 95% CI: 0.63-1.11). This study indicates that COVID-19 vaccination during pregnancy is not associated with self-reported adverse neonatal health outcomes. These findings contribute to the growing body of evidence on the safety of COVID-19 vaccination during pregnancy.

Insights into the Global and Mexican Context of Placental-Derived Pregnancy Complications.

Placental-derived pregnancy complications encompass a range of disorders that hinder optimal fetal development, significantly impacting maternal and neonatal health outcomes. Key conditions include placental insufficiency, preeclampsia, fetal growth restriction (FGR) or intrauterine growth restriction (IUGR), fetal overgrowth, and gestational diabetes mellitus (GDM), which together contribute to a heightened risk of preterm birth, perinatal mortality, and long-term developmental challenges in affected infants. These complications are particularly notable because they generate approximately 80% of pregnancy disorders and pose significant public health concerns across diverse global contexts. Their management continues to face challenges, including a lack of consensus on diagnostic criteria and varied implementation of care standards. While imaging techniques like magnetic resonance imaging (MRI) and Doppler ultrasound have emerged as critical tools in clinical assessment, disparities in access to such technologies exacerbate existing inequalities in maternal and fetal health outcomes. Maternal and pregnancy care is a broad range of services aimed at promoting the well-being of women throughout the perinatal period. However, access to these services is often limited by economic, geographical, and sociocultural barriers, particularly for marginalized groups and women in low- and middle-income countries (LMICs). The implementation of targeted interventions designed to address specific obstacles faced by disadvantaged populations is a crucial component of bridging the gap in health equity in maternal care. Public health authorities and policymakers strive to develop evidence-based strategies that address the interplay between healthcare access, socioeconomic factors, and effective interventions in order to mitigate the adverse effects of placental-derived pregnancy complications. Continued research and data collection are essential to inform future policies and practices to improve outcomes for mothers and infants.

Neonatal mortality and contraceptive utilization following abortion restriction in the Dominican Republic: A difference-in-differences analysis.

Neonatal mortality and contraceptive utilization following abortion restriction in the Dominican Republic: A difference-in-differences analysis.

Management of Newborn Respiratory Distress Using CPAP: Capacity and Readiness of Public Health Facilities in High-Focus Aspirational Districts of India

Background and Objective Adequate respiratory support is crucial for managing respiratory distress in hypoxic newborns. Continuous positive airway pressure (CPAP) devices are widely recommended for this purpose, but their availability and functionality in district-level healthcare facilities in India are unclear. This study aims to assess the capacity and readiness of public health facilities in high-focus Aspirational Districts of India to manage respiratory distress using CPAP and oxygen support. Methods A cross-sectional descriptive study was conducted in 15 functional Special Newborn Care Units (SNCUs) across 14 Aspirational Districts in five Indian states. Data were collected using a semi-structured tool developed in collaboration with state health authorities, aligned to national and global newborn care guidelines. The study focused on assessing the status of infrastructure, human resources, oxygen supply, CPAP utilization, and staff practices. Results Pulse oximeters were available in all SNCUs, with most units using monitor-based devices. Oxygen supply was available at 89% of SNCU beds. Different sources of oxygen supply at SNCUs included oxygen concentrators (93%), manifold rooms (33%), and oxygen plants (13%). CPAP devices were available in only 20% of SNCUs. Oxygen concentrators emerged as the predominant method for oxygen therapy (66.7%), followed by central oxygen supply via manifold room or oxygen plant (26.7%). Monitoring of the oxygenation status of newborns on respiratory support was done at a frequency of at least every 3 hours in 66.7% of units. Conclusion and Global Health Implications The study identified significant gaps in the use of CPAP devices for managing hypoxic newborns in special newborn care units (SNCUs) of Aspirational Districts, reflecting broader healthcare challenges. There is an urgent need to improve oxygen delivery systems and increase CPAP availability in secondary health facilities. These findings call for targeted interventions, capacity building, and strategic resource allocation to enhance neonatal health outcomes in resource-limited settings.