From the Guidelines
Neonatal mortality within 28 days of delivery is primarily caused by prematurity complications, birth asphyxia, infections (particularly sepsis), congenital abnormalities, and birth trauma, with sepsis accounting for approximately 22% of global annual neonatal deaths 1. The most common causes of neonatal mortality can be divided into several key categories, including:
- Prematurity complications
- Birth asphyxia
- Infections, particularly sepsis, which is a major cause of mortality and morbidity in newborns 1
- Congenital abnormalities
- Birth trauma It is essential to note that the causes of neonatal mortality can vary depending on the region, with significant disparities existing between developed and developing countries. When a neonatal death occurs, it is crucial to conduct a thorough investigation to determine the cause, which may include:
- Autopsy (with parental consent)
- Placental examination
- Genetic testing Healthcare facilities should also conduct a systematic review of care provided to identify any preventable factors. Understanding the cause of neonatal mortality is vital not only for closure but also for counseling regarding future pregnancies and improving healthcare system quality. According to a recent study, neonatal sepsis is a significant cause of mortality, with a mortality rate of 11% to 19% in high- and middle-income countries 1. Another study found that women with schizophrenia have a higher risk of neonatal death, with an odds ratio of 1.41 (1.03-1.94) 1. However, the most recent and highest-quality study on this topic is the 2021 systematic review and meta-analysis on gram-negative neonatal sepsis in low- and lower-middle-income countries, which highlights the importance of sepsis as a cause of neonatal mortality 1. Therefore, sepsis prevention and treatment should be a priority in neonatal care, particularly in low- and middle-income countries, to reduce neonatal mortality and improve healthcare system quality 1.
From the Research
Causes of Neonatal Mortality
The causes of neonatal mortality (death of a newborn) within 28 days of delivery are complex and multifaceted. Some of the key factors that contribute to neonatal mortality include:
- Infections, such as sepsis, which can be caused by bacterial, viral, or fungal pathogens 2
- Respiratory distress, which can be caused by premature birth, infection, or other factors 3
- Birth asphyxia, which can cause brain damage and other complications 3
- Congenital anomalies, which can increase the risk of mortality 3
- Premature birth, which is a major risk factor for neonatal mortality 3, 4
Risk Factors for Neonatal Mortality
Several risk factors have been identified that increase the likelihood of neonatal mortality, including:
- Low birth weight, which can increase the risk of infection, respiratory distress, and other complications 3
- Premature birth, which can increase the risk of mortality due to underdeveloped organs and systems 3, 4
- Multiple gestations, which can increase the risk of premature birth and other complications 4
- Maternal health conditions, such as hypertension, diabetes, and infections, which can increase the risk of mortality 4, 5
- Poor quality of maternal and newborn health services, which can increase the risk of mortality due to inadequate care and treatment 5
Impact of Antibiotic Use on Neonatal Mortality
The use of antibiotics in neonates has been shown to have both positive and negative effects on mortality. For example:
- The use of ampicillin and gentamicin has been shown to be effective in reducing the risk of mortality due to sepsis 6
- However, the use of cefotaxime has been shown to increase the risk of mortality due to fungal sepsis and other complications 6
- The choice of antibiotic regimen can have a significant impact on outcomes, and should be carefully considered based on the individual needs of the patient 2