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Early neonatal death: A challenge worldwide
Liisa Lehtonen1, Ana Gimeno2, Anna Parra-Llorca3
1Division of Neonatology, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland.
Insights
Early neonatal death (ENND), the death of newborns within seven days of birth, remains a global challenge. Cost-effective interventions and improved healthcare access can significantly reduce preventable newborn deaths worldwide.
Area of Science:
- Neonatal Health
- Global Public Health
- Pediatrics
Background:
- Early neonatal death (ENND) accounts for 73% of postnatal deaths globally.
- ENND reduction has lagged behind other child mortality goals, increasing its contribution to under-five mortality.
- Causes of ENND vary by industrialization level, with prematurity and congenital anomalies in high-income countries, and perinatal events like asphyxia and infections in low-income regions.
Purpose of the Study:
- To review the global burden and causes of early neonatal death (ENND).
- To identify effective interventions for reducing ENND in both high-income and low-income countries.
- To highlight the potential for future reductions in ENND through targeted initiatives.
Main Methods:
- Review of current research evidence on ENND etiology and outcomes.
- Analysis of factors contributing to ENND across different global economic settings.
- Identification of successful and cost-effective interventions for prevention and management.
Main Results:
- Prematurity, congenital anomalies, asphyxia, and infections are primary drivers of ENND.
- Sudden unexpected early neonatal deaths (SUEND) are emerging as a significant cause.
- High-income countries can improve survival through advanced perinatal care and surveillance; low-income countries benefit from basic, cost-effective interventions.
Conclusions:
- Targeted antenatal, perinatal, and neonatal care strategies are crucial for reducing ENND.
- Implementing accessible interventions like vaccination, hygienic delivery, and resuscitation training can prevent many newborn deaths in low-resource settings.
- Continued focus on neonatal health initiatives holds promise for further reducing ENND and improving infant survival globally.
Abstract:
Early neonatal death (ENND), defined as the death of a newborn between zero and seven days after birth, represents 73% of all postnatal deaths worldwide. Despite a 50% reduction in childhood mortality, reduction of ENND has significantly lagged behind other Millennium Developmental Goal achievements and is a growing contributor to overall mortality in children aged <5 years. The etiology of ENND is closely related to the level of a country's industrialization. Hence, prematurity and congenital anomalies are the leading causes in high-income countries. Furthermore, sudden unexpected early neonatal deaths (SUEND) and collapse have only recently been identified as relevant and often preventable causes of death. Concomitantly, perinatal-related events such as asphyxia and infections are extremely relevant in Africa, South East Asia, and Latin America and, together with prematurity, are the principal contributors to ENND. In high-income countries, according to current research evidence, survival may be improved by applying antenatal and perinatal therapies and immediate newborn resuscitation, as well as by centralizing at-risk deliveries to centers with appropriate expertise available around the clock. In addition, resources should be allocated to the close surveillance of newborn infants, especially during the first hours of life. Many of the conditions leading to ENND in low-income countries are preventable with relatively easy and cost-effective interventions such as contraception, vaccination of pregnant women, hygienic delivery at a hospital, training health care workers in resuscitation practices, simplified algorithms that allow for early detection of perinatal infections, and early initiation of breastfeeding and skin-to-skin care. The future is promising. As initiatives undertaken in previous decades have led to substantial reduction in childhood mortality, it is expected that new initiatives targeting the perinatal/neonatal periods are bound to reduce ENND and provide these babies with a better future.
