Definitions of Early and Very Early Neonatal Death
Early neonatal death is defined as the death of a live-born baby within the first 7 days after birth, while very early neonatal death refers to death occurring within the first 24 hours of life. 1
Standard Definitions
Early Neonatal Mortality
- Early neonatal mortality encompasses deaths occurring from day 0 through day 7 after birth (the first week of life). 1
- This is distinguished from late neonatal mortality, which covers deaths occurring between 8 and 28 days after birth. 1
- Together, early and late neonatal deaths constitute the complete neonatal mortality period (0-28 days). 1
Very Early Neonatal Death (First Day Death)
- Very early neonatal death specifically refers to death within the first 24 hours of life. 2, 3
- This represents the most critical period, with approximately one-third of all infant deaths in developed countries occurring during the first day. 3
- In the United States, first day deaths account for approximately 31% of all infant mortality. 3
Epidemiological Significance
Timing Distribution
- Early neonatal deaths represent 73% of all postnatal deaths worldwide, making this the most critical period for neonatal survival. 2
- More than half (52.4%) of early neonatal deaths occur within the first two days of birth. 4
- Approximately 31% of early neonatal deaths occur within the first hour after delivery. 5
- There is a circadian pattern, with 41% of deaths occurring in the early morning hours (04:00-08:00). 5
Global Burden
- Globally, 75% of all neonatal deaths occur during the first week of life (early neonatal period). 6
- Sub-Saharan Africa accounts for more than 43% of these deaths. 6
- The incidence rate in resource-limited settings can reach 31.79 per 1,000 early neonate days. 6
Clinical Context and Causes
Major Causes by Setting
In high-income countries:
- Prematurity and complications of prematurity are the leading causes. 2
- Congenital anomalies represent a significant proportion. 2
- Sudden unexpected early neonatal deaths (SUEND) have been recently identified as relevant and often preventable causes. 2, 5
In low- and middle-income countries:
- Birth asphyxia and perinatal-related events are extremely relevant. 2, 4
- Infections (including sepsis) are principal contributors. 2, 4, 6
- Prematurity complications remain a leading cause. 2, 4, 6
- Additional causes include meconium aspiration syndrome, necrotizing enterocolitis, and birth injury. 4, 6
Mean Survival Time
- Among neonates who die during the early neonatal period, the mean survival time is approximately 2.72 days. 6
Important Clinical Distinctions
Why the Distinction Matters
- Racial and socioeconomic disparities tend to be larger for first day deaths than for any other category of infant deaths. 3
- Circumstances of early neonatal deaths differ considerably from those of later neonatal deaths, requiring different surveillance and intervention strategies. 3
- Failure to monitor early and late neonatal mortality separately can compromise recognition of distinct epidemiological patterns. 3
- The conventional partition at 28 days has lost much of its epidemiological rationale in countries with low infant death rates, as deaths are increasingly concentrated at the start of the neonatal period. 3