High-Risk Is Routine: SGA, prematurity, and disadvantage in regional newborn care

Regional neonatal care units are increasingly assuming responsibility for managing complex neonatal risks that extend beyond simple measures such as gestational age and birth weight. Drawing on data from a high-risk infant study conducted in regional Australia, along with an analysis of small-for-gestational-age (SGA) subgroups, this keynote contends that encountering “high-risk” cases is not a rare anomaly but constitutes a predictable and routine aspect of regional neonatal service demand. Data from the high-risk cohort reveal that a substantial proportion of Special Care Nursery (SCN) admissions meet high-risk criteria, with recurrent factors including prematurity, SGA status, and adverse sociodemographic conditions. The detailed analysis of the SGA subgroup demonstrates that SGA seldom occurs in isolation; rather, it is often associated with clustered maternal and contextual risk factors, with many infants exposed to multiple concurrent vulnerabilities. Collectively, these findings position SGA as a “signal condition”—an indicator of compounded neonatal and socio-environmental vulnerabilities—highlighting the intersection between biological risks and systemic barriers to post-discharge care. 

This presentation translates these empirical insights into a practical, evidence-based service recommendation: neonatal follow-up in regional contexts should be an integral component of service delivery, rather than an optional adjunct. A risk-stratified, equity-oriented follow-up pathway—preferably co-located within multidisciplinary teams where feasible, or alternatively operationalised through shared care plans and warm handovers—may more effectively align resource allocation with individual patient needs, thereby enhancing access to growth monitoring, feeding support, and neurodevelopmental surveillance. The keynote concludes with pragmatic metrics for assessing regional follow-up performance, including attendance equity, time-to-intervention benchmarks, and completion rates of developmental screenings, to underpin scalable, accountable models of neonatal care tailored for high-risk infants.

Dr Arif Kozgar is a clinician-academic paediatrician and researcher located in Victoria, Australia, with more than 20 years of experience in clinical practice, academia, and medical education. He is Director of Clinical Training at Latrobe Regional Health and an Adjunct Senior Lecturer at Monash School of Rural Health, Monash University, where he teaches and assesses medical students and supervises scholarly projects. His research focuses on translational research on neonatal outcomes, regional perinatal epidemiology, and paediatric allergy and diabetes. He has published in peer-reviewed journals and leads workforce and education reform initiatives supporting junior doctor training and patient safety.