Newborn Mortality

Overview

Globally 2.4 million children died in the first month of life in 2020. There are approximately 6700 newborn deaths every day, amounting to 47% of all child deaths under the age of 5 years, up from 40% in 1990.

The world has made substantial progress in child survival since 1990. Globally, the number of neonatal deaths declined from 5 million in 1990 to 2.4 million in 2020. However, the decline in neonatal mortality from 1990 to 2020 has been slower than that of post-neonatal under-5 mortality.

The chances of survival from birth varies widely depending on where a child is born. Sub-Saharan Africa had the highest neonatal mortality rate in 2020 at 27 (25–­­32) deaths per 1000 live births, followed by central and southern Asia with 23 (21–­­25) deaths per 1000 live births. A child born in sub-Saharan Africa is 10 times more likely to die in the first month than a child born in a high-income country. Country-level neonatal mortality rates in 2020 ranged from 1 death per 1000 live births to 44 and the risk of dying before the 28^th day of life for a child born in the highest-mortality country was approximately 56 times higher than the lowest-mortality country.

Causes

Most neonatal deaths (75%) occur during the first week of life, and in 2019, about 1 million newborns died within the first 24 hours. Preterm birth, childbirth-related complications (birth asphyxia or lack of breathing at birth), infections and birth defects caused most neonatal deaths in 2019. From the end of the neonatal period and through the first 5 years of life, the main causes of death are pneumonia, diarrhoea, birth defects and malaria. Malnutrition is the underlying contributing factor, making children even more vulnerable to severe diseases.

COVID-19 disease and newborn survival

The evidence on deaths directly attributable to COVID-19 infection is strongly age-dependent, with children and adolescents least affected. Children under-5 years represent approximately 2% of the global cases (2 231 276) and 0.1% of the global deaths (1902) (1).

Data from civil registration and vital statistic systems, health management information systems from 80 countries as well as specific country-wide monitoring systems (Mozambique and South Africa) indicate no significant deviation from expected mortality for this age group for 2020 and in some cases indicate fewer deaths than would be expected from historical data. As more data comes in from countries, and further analyses are performed, these results may change for 2021.

Priority Strategies

Most newborn deaths take place in low and middle-income countries. It is possible to improve survival and health of newborns and end preventable stillbirths by reaching high coverage of quality antenatal care, skilled care at birth, postnatal care for mother and baby, and care of small and sick newborns. In settings with well-functioning midwife programmes the provision of midwife-led continuity of care (MLCC) can reduce preterm births by up to 24%. MLCC is a model of care in which a midwife or a team of midwives provide care to the same woman throughout her pregnancy, childbirth and the postnatal period, calling upon medical support if necessary.

With the increase in facility births (almost 80% globally), there is a great opportunity for providing essential newborn care and identifying and managing high risk newborns.  However, few women and newborns stay in the facility for the recommended 24 hours after birth, which is the most critical time when complications can present. In addition, too many newborns die at home because of early discharge from the hospital, barriers to access and delays in seeking care. The 4 recommended postnatal care contacts delivered at health facility or through home visits play a key role to reach these newborns and their families.

Accelerated progress for neonatal survival and promotion of health and wellbeing requires strengthening quality of care as well as ensuring availability of quality health services or the small and sick newborn.

Essential newborn care

All babies should receive the following:

• thermal protection (e.g. promoting skin-to-skin contact between mother and infant);
• hygienic umbilical cord and skin care;
• early and exclusive breastfeeding;
• assessment for signs of serious health problems or need of additional care (e.g. those that are low-birth-weight, sick or have an HIV-infected mother); and 
• preventive treatment (e.g. immunization BCG and Hepatitis B, vitamin k and ocular prophylaxis)

Families should be advised to:

• seek prompt medical care if necessary (danger signs include feeding problems, or if the newborn has reduced activity, difficult breathing, a fever, fits or convulsions, or feels cold);
• register the birth; and
• bring the baby for timely vaccination according to national schedules.

Some newborns require additional attention and care during hospitalization and at home to minimize their health risks.

Low birth weight and preterm babies require the following:

• if a low-birth-weight newborn is identified at home, the family should be helped in locating a hospital or facility to care for the baby;
• increased attention to keeping the newborn warm, including skin-to-skin care, unless there are medically justifiable reasons for delayed contact with the mother;
• assistance with initiation of breastfeeding, such as helping the mother express breast milk for feeding the baby from a cup or other means if necessary;
• extra attention to hygiene, especially hand washing;
• extra attention to danger signs and the need for care; and
• additional support for breastfeeding and monitoring growth.

Sick newborns:

• Danger signs should be identified as soon as possible in health facilities or at home and the baby referred to the appropriate service for further diagnosis and care;
• If a sick newborn is identified at home, the family should be helped in locating a hospital or facility to care for the baby.

Newborns of HIV-infected mothers require:

• preventive antiretroviral treatment (ART) for mothers and newborns to prevent opportunistic infections;
• HIV testing and care for exposed infants; and
• counselling and support to mothers for infant feeding. Community health workers should be aware of the specialized issues around infant feeding. Many HIV-infected newborns are born prematurely and are more susceptible to infections.

WHO response

WHO is working with ministries of health and partners to 1) strengthen and invest in care, particularly around the time of birth and the first week of life as most newborns are dying in this time period; 2) improve the quality of maternal and newborn care from pregnancy to the entire postnatal period, including strengthening midwifery; 3) expand quality services for small and sick newborns, including through strengthening neonatal nursing; 4) reduce inequities in accordance with the principles of universal health coverage, including addressing the needs of newborns in humanitarian and fragile settings; 5) promote engagement of and empower mothers, families and communities to participate in and demand quality newborn care; and 6) strengthen measurement, programme-tracking and accountability to count every newborn and stillbirth.

Top 10 countries with the highest number (thousands) of newborn deaths, 2020

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1. WHO Coronavirus (COVID-19) Dashboard | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data (https://covid19.who.int/measures); last accessed 17 December 2021.