**3. Change is compulsorily needed**

Neonatal health care professionals in West Africa, especially Nigeria, need to understand that the world expects them to apply whatever science they can manage to deliver a drastic reduction in the neonatal mortality rates as it has been known for the last 10 years. It ought to be a challenge to the health care providers in this country that no significant improvements have been achieved, even after ten years of accelerated campaigning and spending—from the 2007 demographic data of the World Health Organization (WHO) to that of Nigeria's Federal Ministry of Health (FMoH) of 2010, to that of UNICEF's 2012, and perhaps up to the indices of 2017 (**Figure 1**) [1, 11–14].

The question that remained unanswered is whether there are any more untried ideas left for the Nigeria's FMoH and the other custodians of neonatal health in Nigeria that can help lower their well-known horrible indices, including:

(a) Neonatal deaths accounting for nearly 50% of all deaths of children under 5 years of age [1, 15]

(b) Nearly 80% of all deceased neonates dying within their first 1 week of life [14, 16]

**Figure 1.** Daily newborn mortality over last 8 years of MDG.

This showed that most deceased neonates died before their 7th postnatal day, beyond which most surviving neonates would successfully go home alive. We hypothesize that after the first quarter of neonatal life, i.e., 7 of 28 days, most Nigerian neonates are strong enough to contribute their minimal quotas in resisting and fighting their various debilitating morbidities, howbeit, within a conducive and stable physiological state. The first few days after birth are their greatest period of need for external life support systems and procedures. Inadequate support and procedures during this period would normally be associated with such high rate of death as reported in Nigeria. The most vulnerable of the neonates is the premature ones who may necessarily require knowledgeable support for survival. Nigerian authors have shown that mortality for very preterm and extremely low birthweight neonates at some hospital centers can be quite high, even as high as 933/1000 [17–20]. It is our opinion that the current Nigerian conventional facility-based practices during early neonatal life is inadequate or fundamentally faulty. Our resonating questions remain: Has Nigeria got any other ideas for preventing such high rate of early neonatal deaths that has not yet been tried since the last 10 years as these are urgently needed? Is it time for the FMoH and the establishments to come out openly to accept the failure? Is it time to have compassion on the neonates and search for other sustainable, and perhaps, unconventional methods as have been demonstrated in few pockets of Nigerian centers? The time cannot be any sooner than now.
