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Updated: Jul 13, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Newborn Health and Child Mortality Across England
David Odd1,2, Tom Williams1, Sylvia Stoianova1
1National Child Mortality Database, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
Insights
Most childhood deaths are linked to neonatal illness, highlighting the need for improved perinatal care to reduce mortality. Addressing neonatal conditions can significantly impact child health outcomes.
Area of Science:
- Neonatal health
- Child mortality
- Epidemiology
Background:
- The long-term effects of neonatal illness on childhood mortality remain unclear.
- Understanding the link between neonatal conditions and subsequent child deaths is crucial for public health.
Purpose of the Study:
- To determine the association between neonatal illness and deaths in children under 10 years.
- To identify underlying conditions in children who died following neonatal illness.
Main Methods:
- A population-based cohort study using the National Child Mortality Database in England.
- Inclusion criteria: children who died before age 10 between April 2019 and March 2021.
- Analysis involved comparing mortality risks stratified by neonatal illness status.
Main Results:
- Over 71% of children who died before age 10 had evidence of neonatal illness.
- Neonatal illness significantly increased the risk of death before age 10 (RR, 13.82).
- Children with neonatal illness were more likely to have developmental, neurological, or respiratory disorders.
Conclusions:
- Neonatal illness is associated with a substantial proportion of childhood deaths.
- Improvements in perinatal care and reduction of neonatal morbidity could significantly lower child mortality.
- Further research into the specific causes of death following neonatal illness is warranted.
Importance:
Although the immediate impact of neonatal illness is well recognized, its wider and longer term outcomes on childhood mortality and the role of specific illnesses across childhood are unclear.
Objective:
To investigate how many deaths in childhood are associated with neonatal illness and the underlying conditions of the children who died.
Design, Setting, And Participants:
This population-based cohort study of children who died before age 10 years in England between April 1, 2019, and March 31, 2021, used data from the National Child Mortality Database. Data analysis was performed from September 2022 to May 2023.
Exposure:
Children who received care in a neonatal unit after birth plus those who died in the first day of life, before admission to a neonatal unit, were considered to have likely neonatal illness.
Main Outcomes And Measures:
The primary outcome was the relative risk (RR) of dying, stratified by likely neonatal illness and specific neonatal conditions. Comparisons were made using the χ2 or likelihood ratio test, as appropriate.
Results:
A total of 4829 children were included (median [IQR] age at death, 28 [2-274] days; 2606 boys [54.8%]; 2690 White children [64.0%]). Overall, 3456 children who died (71.6%) had evidence of likely neonatal illness. Children with neonatal illness were more likely to die before their tenth birthday than those without evidence of neonatal illness (RR, 13.82; 95% CI, 13.00-14.71). The estimated population-attributable risk fraction for neonatal illness among all deaths before age 10 years was 66.4% (95% CI, 64.9%-67.9%). Children with preceding neonatal illness who died were more likely to have underlying behavioral or developmental disorders (odds ratio [OR], 3.31; 95% CI, 2.47-4.42), chronic neurological disease (OR, 3.00; 95% CI, 2.51-3.58), and chronic respiratory disease (OR, 3.01; 95% CI, 2.43-3.73) than children without neonatal illness.
Conclusions And Relevance:
In this cohort study, most children who died before age 10 years had some evidence of neonatal illness, and they died of a range of causes, including infections and sudden, unexpected, unexplained death. These findings suggest that improvements to perinatal morbidity, an area with an existing evidence base for improvement, may have important impacts on child health across the next decade.
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