Caffeine for the care of preterm infants in sub-Saharan Africa: a missed opportunity?

In 2019, 2.4 million neonates (infants <28 days of age) died globally. Of these, over 80% were preterm infants (<37 weeks gestation), with the majority born in low-income and middle-income countries.1 Complications of preterm birth, largely from respiratory distress syndrome due to surfactant deficiency, pneumonia or apnoea of prematurity (AOP), are now the leading cause of under 5 mortality globally.1 These conditions are frequently fatal in the absence of effective ventilatory support which is commonplace in neonatal units across sub-Saharan Africa. Although the global neonatal mortality rate (NMR) has halved over the past three decades, significant regional disparities remain. These correlate with World Bank and International Monetary Fund estimates of the proportion of the population living on less than US$1.90 a day, with the majority of poorer countries being in sub-Saharan Africa.1 2 As the region with the highest NMR of 27 per 1000 live births, it is estimated that a baby born in in sub-Saharan Africa is 10 times more likely to die than one born in a high income country.1 Countries in sub-Saharan Africa are unlikely to meet the global target of no more than 12 newborn deaths per 1000 live births by 2030.3 In 2017, 75 countries (almost half from sub-Saharan Africa) signed up to the ‘Every Newborn Action Plan’ that has strategic global and national actions and milestones to address gaps in maternal and newborn care.4 This ambitious commitment requires evidence-based interventions5 and innovative strategies to improve neonatal survival and longer-term outcomes.