Integrated Neonatal Care Technologies for Resource-Limited Settings: A Narrative Review of Innovations and System-Level Implementation (Published)
Neonatal mortality remains disproportionately concentrated in low- and middle-income countries, where deaths related to prematurity, intrapartum complications, infection, hypothermia, and severe jaundice persist despite the availability of effective interventions. This clinical review examines how integrated neonatal care technologies can strengthen care for small and sick newborns in resource-limited settings when devices are deployed within coordinated service-delivery systems rather than as isolated donations. Particular attention is given to respiratory support, pulse oximetry, thermal care devices, bilirubin screening, LED phototherapy, point-of-care diagnostics, tele-neonatology, electronic registries, and referral-support tools. The review argues that the value of technology is inseparable from the systems that sustain it, including oxygen reliability, resilient electricity, biomedical maintenance, consumable supply chains, workforce competencies, transport readiness, and routine data use. Available evidence suggests that low-cost and ruggedized technologies improve outcomes most effectively when they are linked to protocols, staff training, supervision, and quality-improvement processes. Persistent barriers include unstable power supply, weak oxygen ecosystems, limited neonatal nursing capacity, fragmented procurement, delayed referral, poor interoperability, and inadequate financing for maintenance and replacement. Future progress will depend on human-centered design, lifecycle costing, local repair capacity, adaptive regulation, implementation research, and stronger alignment between neonatal technology planning and national maternal-newborn health strategies. Integrated deployment is therefore more likely than stand-alone equipment donation to produce durable gains in neonatal survival, safety, and equity in high-burden settings.
Keywords: Appropriate Technology, digital health, health systems, neonatal care, neonatal mortality, resource-limited settings