The Lancet, the British medical journal, has published four reports, called the ''Neonatal Survival Series,'' about health care for babies in the first four weeks of life. All four can be found at

The introduction to the first report paints a stark picture: Millions of infants die every year, mostly in the world's poorest regions, and about three-quarters of the deaths are easily preventable. Here is an excerpt.

The proportion of child deaths that occurs in the neonatal period (38 percent in 2000) is increasing. Every year, an estimated 4 million babies die in the first 4 weeks of life. A similar number are stillborn, and 0.5 million mothers die from pregnancy-related causes. Three-quarters of neonatal deaths happen in the first week -- the highest risk of death is on the first day of life. Almost all (99 percent) neonatal deaths arise in low-income and middle-income countries .

The highest numbers of neonatal deaths are in south-central Asian countries and the highest rates are generally in sub-Saharan Africa. The countries in these regions (with some exceptions) have made little progress in reducing such deaths in the past 10-15 years. Globally, the main direct causes of neonatal death are estimated to be preterm birth (28 percent), severe infections (26 percent ) and asphyxia (23 percent). Neonatal tetanus accounts for a smaller proportion of deaths (7 percent), but is easily preventable. Low birthweight is an important indirect cause of death. Preventing deaths in newborn babies has not been a focus of child survival or safe motherhood programmes.

While we neglect these challenges, 450 newborn children die every hour, which is unconscionable in the 21st century.