A physician survey on research and implementation priorities for caffeine citrate use in newborn care in sub-Saharan Africa

Background: Evidence on caffeine citrate (CC) for apnoea of prematurity (AOP) originate from high-income countries. This study aimed to develop consensus on research design for evidence in sub-Saharan Africa (SSA). Methods: We surveyed physicians in newborn units across SSA to assess their opinions on CC research and their preferred study designs. Participants rated four study designs: a) an observational before-and-after study; a randomized controlled trial (RCT) of b) caffeine versus placebo; c) caffeine versus aminophylline; d) a traditional or stepped wedge cluster trial. They assessed each design using a Likert scale for evidence, feasibility, and ethics considerations. Results: Ninety-two newborn physicians across 21 SSA countries participated. Most respondents (72%) felt a trial on CC in SSA was important. An RCT of CC vs. aminophylline and a cluster RCT had the highest ratings for importance (82% and 73%), feasibility (75% and 69%), and ethical appropriateness (78% and 69%), while an RCT of CC vs. placebo received the lowest ratings in these categories. Conclusions: Newborn SSA physicians agree that local research on CC is needed and rated an individual or cluster RCT comparing caffeine with aminophylline to evaluate CC's impact on key clinical outcomes.