Some centres such as the University of Nigeria Teaching Hospital have introduced a protocol to ensure efficient pre- and post-operative resuscitation and care, preservation of body heat, decompression of the stomach with a nasogastric tube, evacuation of meconium, respiratory support and parental nutrition. As a result their mortality rate has fallen from 65% to 35%. However, Hadley notes that in Durban, despite access to NICU and PN, the overall mortality is still 43%, with sepsis being the leading cause of death. They stress the importance of meticulous central line care and a need for improved antenatal care and delivery within a tertiary paediatric surgery centre. A protocol focussed on early and aggressive resuscitation, avoidance of compartment syndrome, appropriate IV access and proactive nutritional interventions may help SSA start to realise the improvements in outcome as seen in HIC over the last 55-years. Implementing such interventions should have a knock on effect to strengthen the neonatal healthcare system in SSA and hence help to improve outcomes for all newborns with surgical conditions.