A reduction in large animal research threatens the perinatal translation research pipeline.

More than 1 in 10 babies are compromised by preterm birth, low birthweight, maternal pregnancy complications or perinatal hypoxia-ischemia, leading to death or lifelong disability. Advancements in pregnancy and newborn care to date have been underpinned by mechanistic and physiological insights from fundamental discovery science. However, there are growing challenges to the perinatal research pipeline that threaten the next breakthroughs. Reduced funding, discipline-specific publishing, and high attrition are reducing pipeline research capacity and particularly large animal research; over the last two decades there has been a 12.6% decrease in the number of institutes that conduct large animal perinatal studies. Furthermore, paradoxically, over-prioritisation of translational research has come at the expense of discovery science. The complexity of fetal and newborn physiology, transition at birth, pathophysiology, multi-hit and multi-organ insults, and the progressive nature of development and injury, mean that the fetus and newborn are unique study subjects. The fetus and newborn are not small adults. Consequently, progression to clinical trials must acknowledge all available evidence provided through preclinical and clinical discoveries prior to adopting new interventions. The next critical innovations towards a healthy start to life need a thriving perinatal research pipeline that values and prioritises discovery evidence. IMPACT: Ensuring a healthy start to life for all infants needs new discoveries. But there are growing challenges to the perinatal research pipeline that threaten the next advances. Poor funding, competitive publishing, and high attrition are reducing discovery research capacity and reducing large animal research. The unique physiology and ongoing organ development in the fetus and neonate means that they are not small adults, and we must support the perinatal research pipeline to accumulate gold-standard evidence that will inform the next successful advances for better newborn health.