Four million newborn deaths: Is the global research agenda evidence-based?

Four million neonates die each year. These deaths are mostly in low-income countries, but neonatal mortality and morbidity are also a priority burden in high-income countries. Epidemiological evidence suggests newborn research would prioritise the poorest families; birth and the first days of life; major causes particularly infections, preterm birth and asphyxia; and include preventive strategies as well as improved care. However research investment is not commensurate to burden, and there is a mismatch with current research priorities. South Asia and sub Saharan Africa, with 75% of the burden, expend around US$20 million per year on newborn research, a fraction of what is spent on a smaller proportion of health problem in rich countries. We propose a research pipeline of description, discovery, development of solutions and delivery of research with scale-up to reach the poorest families. Listing research options and applying quantitative scoring enables systematic, transparent research prioritisation. As well as a research pipeline, a "people pipeline" is required to generate research capacity in low-income countries. © 2008 Elsevier Ltd. All rights reserved.