TY - JOUR T1 - Caffeine for the care of preterm infants in sub-Saharan Africa: a missed opportunity? JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2021-007682 VL - 6 IS - 12 SP - e007682 AU - Helen M Nabwera AU - Osayame A Ekhaguere AU - Haresh Kirpalani AU - Kathy Burgoine AU - Chinyere V Ezeaka AU - Walter Otieno AU - Stephen J Allen AU - Nicholas D Embleton A2 - , Y1 - 2021/12/01 UR - http://gh.bmj.com/content/6/12/e007682.abstract N2 - Summary boxThe majority of the estimated 15 million preterm infants (<37 weeks gestation) delivered worldwide are born in low-income and middle-income countries.In sub-Saharan Africa, nearly half of very preterm infants (<32 weeks gestation) die in the first 28 days and sparse data indicates neurodevelopmental impairment in many of those who survive.Apnoea of prematurity (AOP), a common complication of very preterm infants, contributes significantly to mortality and morbidity.In resource-limited settings, aminophylline is used for prevention and treatment of AOP but concerns remain about its safety and efficacy given limited therapeutic drug monitoring.Caffeine citrate, the drug of choice for the prevention and treatment of AOP in high-income countries, is either unavailable or prohibitively expensive in sub-Saharan Africa.Use of caffeine citrate for AOP in sub-Saharan Africa could significantly reduce mortality and morbidity in very preterm infants.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 … ER -