OBJECTIVE: To examine the prevalence of novel newborn types among 165 million live births in 23 countries from 2000 to 2021. DESIGN: Population-based, multi-country analysis. SETTING: National data systems in 23 middle- and high-income countries. POPULATION: Liveborn infants. METHODS: Country teams with high-quality data were invited to be part of the Vulnerable Newborn Measurement Collaboration. We classified live births by six newborn types based on gestational age information (preterm <37 weeks versus term ≥37 weeks) and size for gestational age defined as small (SGA, <10th centile), appropriate (10th-90th centiles), or large (LGA, >90th centile) for gestational age, according to INTERGROWTH-21st standards. We considered small newborn types of any combination of preterm or SGA, and term + LGA was considered large. Time trends were analysed using 3-year moving averages for small and large types. MAIN OUTCOME MEASURES: Prevalence of six newborn types. RESULTS: We analysed 165 017 419 live births and the median prevalence of small types was 11.7% - highest in Malaysia (26%) and Qatar (15.7%). Overall, 18.1% of newborns were large (term + LGA) and was highest in Estonia 28.8% and Denmark 25.9%. Time trends of small and large infants were relatively stable in most countries. CONCLUSIONS: The distribution of newborn types varies across the 23 middle- and high-income countries. Small newborn types were highest in west Asian countries and large types were highest in Europe. To better understand the global patterns of these novel newborn types, more information is needed, especially from low- and middle-income countries.

Catholic University of the Maule Región del Maule Chile

Centre for Research Excellence in Stillbirth MRI UQ Mater Research Institute The University of Queensland Brisbane Queensland Australia

Centre of Data and Knowledge Integration for Health Instituto Gonçalo Moniz Fiocruz Bahia Fundação Oswaldo Cruz Salvador Brazil

Centro de Investigación en Salud Materna e Infantil Centro de Investigación para el Desarrollo Integral y Sostenible and School of Medicine Universidad Peruana Cayetano Heredia Lima Peru

Clinical Epidemiology Division Department of Medicine Solna Karolinska Institutet Stockholm Sweden

Department of Clinical Epidemiology Aarhus University Aarhus N Denmark

Department of Community Medicine Preventive Medicine and Public Health Research Centre Iran University of Medical Sciences Tehran Iran

Department of Data Analysis Institute of Health Information and Statistics of the Czech Republic Prague Czech Republic

Department of Health Sciences College of Life Sciences University of Leicester Leicester UK

Department of Knowledge Brokers THL Finnish Institute for Health and Welfare Helsinki Finland

Department of Maternity and Sexual Health Team Public Health Scotland Edinburgh UK

Department of Mother and Child Health Institute for Clinical Effectiveness and Health Policy Buenos Aires Argentina

Department of Obstetrics and Gynaecology Faculty of Medicine University of Cyberjaya Cyberjaya Malaysia

Department of Obstetrics and Gynaecology Hospital Sultanah Aminah Ministry of Health Johor Bahru Malaysia

Department of Obstetrics and Gynaecology Institute for the Care of Mother and Child Prague Czech Republic

Department of Obstetrics and Gynaecology Korea University College of Medicine Seoul South Korea

Department of Obstetrics and Gynaecology University of British Columbia Vancouver British Columbia Canada

Department of Paediatrics Alzahra Hospital Tabriz Iran

Department of Paediatrics and Adolescent Medicine American University of Beirut Beirut Lebanon

Department of Wellness and Health Catholic University of Uruguay Montevideo Uruguay

Directorate of Health Information Ministry of Health Mexico City Mexico

Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia

Hamad Medical Corporation Doha Qatar

Maternal Adolescent Reproductive and Child Health Centre London School of Hygiene and Tropical Medicine London UK

Mexican Society of Public Health Mexico City Mexico

National Perinatal Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford UK

Perined Utrecht The Netherlands

Pontificia Universidad Católica de Chile Santiago Chile

Public Health Scotland Edinburgh UK

Queen's Management School Queen's University Belfast Belfast UK

School of Governance Law and Society Estonian Institute for Population Studies Tallinn University Tallinn Estonia

School of Natural and Built Environment Queen's University Belfast Belfast UK

The Generation R Study Group Department of Paediatrics Division of Neonatology Erasmus MC Sophia Children's Hospital University Medical Centre Rotterdam Rotterdam The Netherlands

Usher Institute University of Edinburgh Edinburgh UK

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