Neonatal Death

When a baby dies within the first 28 days of life, families face one of the most difficult experiences imaginable. Understanding what neonatal death means, its causes, and the support available can help families navigate this profound loss.

Table of contents

• What is neonatal death?
• Causes of neonatal death
• Birth defects that can cause neonatal death
• Pregnancy complications linked to neonatal death
• The global burden of neonatal death
• Understanding why your baby died
• Physical changes for mothers after neonatal death
• Spending time with your baby
• Getting support and counseling

What is neonatal death?

Neonatal death is defined as the death of a baby in the first 28 days of life^[1]. This period is also called the neonatal period, which covers the time from birth through the first month of a baby’s life^[8]. It is different from stillbirth, which happens when a baby dies between 20 weeks of pregnancy and birth^[5].

The neonatal period can be further divided into two parts. Early neonatal death occurs in the first seven days of life, while late neonatal death happens between 8 and 28 days^[8]. About two-thirds of all neonatal deaths occur during the first week of life^[11].

In the United States, neonatal death happens in about 3.58 out of every 1,000 births, which is less than 1 percent of all births each year^[1]. In Australia, there are approximately 700 neonatal deaths per year^[5]. Whether a baby dies soon after birth or after surviving a few weeks, it is a very difficult experience for the whole family^[3].

Causes of neonatal death

The most common causes of neonatal death include problems related to being born too early, being born too small, and having medical conditions present at birth^[1]. Many babies die from a combination of factors rather than a single cause.

Preterm birth is one of the leading causes of neonatal death. Babies born before 37 weeks of pregnancy may not have fully developed organs, especially their lungs, which makes survival difficult^[1].

Low birthweight occurs when a baby is born weighing less than 5 pounds, 8 ounces. Babies with low birthweight often struggle with temperature control, breathing, and fighting infections^[1].

Asphyxia happens when a baby doesn’t get enough oxygen before or during birth. This lack of oxygen can damage vital organs, particularly the brain, and can be life-threatening^[1].

Infections are a major cause of neonatal death worldwide. These can include sepsis (a blood infection), meningitis (an infection of the brain and spinal cord), or pneumonia (an infection of the lungs)^[1]. More than 20 percent of children born in developing countries acquire an infection during the neonatal period, leading to an estimated 30 to 40 percent of all neonatal deaths^[11].

Respiratory distress syndrome is a lung problem that occurs most commonly in babies born before 34 weeks of pregnancy. Babies with this condition don’t have enough of a protein called surfactant, which keeps small air sacs in the lungs from collapsing^[1].

Intraventricular hemorrhage is bleeding in the brain. Most brain bleeds are mild and resolve themselves with no or few lasting problems, but more severe bleeds can cause serious problems for a baby^[1].

Necrotizing enterocolitis is a problem with a baby’s intestines. It can cause feeding problems, a swollen belly, and diarrhea^[1].

Sometimes a baby might die for many reasons in the first 4 weeks after birth, including being born prematurely, having birth defects, or becoming sick with an infection. There might have been complications during labor. Sometimes we just don’t know why a baby dies^[3].

Birth defects that can cause neonatal death

Birth defects are medical conditions that are present when a baby is born. Some birth defects are so serious that they can lead to a baby’s death in the first weeks of life^[1].

Heart defects are among the most common birth defects that cause neonatal death. Some babies who have serious heart defects may not survive long enough to have treatment, or they may not survive after treatment^[1].

Lung defects can also be life-threatening. A baby may be born with problems in one or both lungs, or may have lungs that aren’t fully developed^[1].

Certain genetic conditions can cause neonatal death. These are conditions caused by changes in a baby’s genes or chromosomes that affect how the body develops or functions^[1].

Neural tube defects are serious birth defects of the brain and spine. These include conditions like anencephaly, where major parts of the brain and skull do not develop properly^[1].

Pregnancy complications linked to neonatal death

Some pregnancy complications may increase the risk of neonatal death. Preeclampsia is a serious condition during pregnancy that involves high blood pressure and can affect the mother’s organs and the baby’s growth^[1].

Problems with the placenta, umbilical cord, and amniotic sac can also lead to neonatal death. The placenta is the organ that provides nutrients and oxygen to the baby during pregnancy. The umbilical cord connects the baby to the placenta. The amniotic sac is the fluid-filled membrane that surrounds and protects the baby^[1].

If the membranes of the amniotic sac rupture and fluid is lost too early, the baby may deliver preterm or become infected and not survive^[1].

The global burden of neonatal death

Globally, 2.3 million children died in the first 28 days of life in 2022. This means there are approximately 6,500 newborn deaths every day^[2]. Current estimates place the annual neonatal death toll at 4 million worldwide^[11].

Nearly half (47%) of all deaths in children under 5 years of age occur in the newborn period, making the first 28 days of life among the most vulnerable periods^[2]. About 60 percent of all deaths to children under age 5 and nearly two-thirds of infant deaths (birth to 12 months) occur during the neonatal period^[11].

Approximately 98 percent of neonatal deaths occur in developing countries^[11]. Sub-Saharan Africa had the highest neonatal mortality rate in 2022 at 27 deaths per 1,000 live births, followed by central and southern Asia with 21 deaths per 1,000 live births^[2]. The highest annual neonatal rates are in South Asia, where an estimated 51 deaths occur for every 1,000 live births^[11].

By comparison, the rates per 1,000 live births are 42 in Africa, 25 in Latin America, and fewer than 10 in Europe and North America^[11]. In sub-Saharan Africa, the risk of death in the first month of life is 11 times higher than in some other regions^[2].

The world has made substantial progress in child survival since 1990. Globally, the number of neonatal deaths declined from 5.0 million in 1990 to 2.3 million in 2022, representing a 44% decrease^[2]. However, the decline in neonatal mortality has been slower than that of deaths in older children^[2].

Understanding why your baby died

Your baby’s health care provider can help you learn as much as possible about why your baby died^[1]. An autopsy is a medical examination of a baby’s body after death that may help you find out why your baby died. You can choose whether to have an autopsy done^[1].

Your doctor might ask if you’d like to have an autopsy done on your baby to find out more about why your baby died^[3]. Most neonatal deaths occur at home following unsupervised deliveries, so little accurate information is available as to their causes. This makes it even more important for families who have access to medical care to consider an autopsy if they want answers^[11].

Your health care provider or a genetic counselor (a professional trained in genetics and counseling) may help you learn why your baby died and whether there’s a risk of the same problems in another pregnancy^[1].

It’s important to know that sometimes, even after all possible tests and examinations, doctors cannot determine exactly why a baby died. This uncertainty can be very difficult for families to accept^[3].

Physical changes for mothers after neonatal death

After your baby dies, your body will go through physical changes similar to what happens after any birth. Understanding these changes can help you know what to expect^[3].

After birth, you might have some vaginal bleeding for 5 to 10 days, though this can last up to 6 weeks. This is normal. However, it’s important to see a doctor if you have heavy bleeding that doesn’t stop, severe abdominal cramps, or signs of a fever^[3].

After your baby dies, it can be a few weeks before your breasts stop producing milk. This can be a physically and emotionally difficult time. There are medicines for managing breast discomfort or suppressing milk supply if you need them. Your midwife, doctor, or obstetrician will help you with this^[3].

If your breasts are comfortable during this period, there’s no need to express milk. Expressing will stimulate breastmilk supply and make it take longer for your breasts to stop producing milk. But if your breasts are swollen, hard, and painful, you’ll need to express over a few days. Express just enough to keep your breasts comfortable, and slowly reduce the amount of milk you express each day^[3].

If you have breast pain, swelling, warmth, fever, and chills, it’s important to see a doctor. This might be the beginnings of mastitis, which is an inflammation of the breast that can lead to an infection^[3].

Spending time with your baby

Spending time with your baby creates memories and lets you acknowledge your baby as part of your family. Remembering and sharing these memories over time helps some people grieve. How you make memories of your baby is up to you and your family^[3].

It’s okay for you to take as long as you need. Try not to feel pressured by other people’s expectations or experiences^[3].

When your baby dies, the hospital staff will make sure you can spend time with your baby. You might spend this time holding and cuddling your baby. Neonatal nurses and midwives can also help you to dress, bathe, and take photos of your baby^[3].

You might be able to spend a few days with your baby or take your baby home for a while. Most hospitals have special cold cots for this purpose. You can ask your midwife about this option^[3].

A neonatal death might affect other members of your family, including children, grandparents, and other relatives. You can decide whether you want to invite them to spend time with your baby^[3].

Most hospitals will help you put photos, footprints, and a lock of your baby’s hair into a memory box. You can take this box home with you when you leave the hospital. Some hospitals might be able to look after this box for you until you feel ready to collect it, or you can ask a trusted family member or friend to collect it for you^[3].

Midwives, doctors, nurses, social workers, pastoral carers, bereavement midwives, and funeral directors will help you with the things you need and want to do after your baby’s death. This includes organizing a funeral^[3].

Getting support and counseling

Your baby’s death can bring intense feelings of grief, emptiness, anger, anxiety, and depression. It’s okay to feel however you feel—there’s no one or right way to respond^[3].

Getting counseling and support can help you cope with your baby’s death^[1]. Healthcare providers, including social workers and bereavement counselors, can connect you with resources and support groups for families who have experienced neonatal death.

If you’ve been told your baby is unlikely to survive beyond 4 weeks, you can still spend time together from the moment your baby is born. Neonatal nurses and midwives can help you hold and cuddle your baby and spend as much time as possible as a family together^[3].