When a baby dies in the first 28 days of life, it is called neonatal death. In the United States in 2006, about 19,000 babies died in their first month (1).
As parents attempt to cope with a loss, they may have many questions about what happened to their baby. The following may help parents discuss the loss of their baby with their health care providers.
What are the most common causes of neonatal death? Premature birth (before 37 completed weeks of pregnancy) is the most common cause of neonatal death. Prematurity and its complications cause about 25 percent of neonatal deaths (2). The later a baby is born, the more likely he is to survive. Almost 30 percent of babies born at 23 weeks of pregnancy survive, while about 50 to 60 percent of babies born at 24 weeks, about 75 percent born at 25 weeks, and more than 90 percent born at 27 to 28 weeks, survive (3,4,5).
More than 12 percent of babies born in the United States each year are premature (6). The causes of premature birth are not thoroughly understood. Three groups of women are at greatest risk for premature birth:
In some cases, a pregnant woman may have health problems (such as high blood pressure), pregnancy complications (such as placental problems) or lifestyle factors (such as smoking) that increase her risk of delivering prematurely. More often, preterm labor develops unexpectedly in a pregnancy that had been problem-free.
Premature babies, especially those born at less than 32 weeks of pregnancy and weighing less than 3 1/3 pounds, may develop serious complications that can sometimes cause neonatal death. Some of these complications include:
While deaths due to prematurity are still too common, the outlook for premature babies is improving. Surfactant and other treatments are saving more premature babies after birth. And treatment before birth can sometimes prevent or lessen the complications of prematurity. Women who are likely to deliver between 24 and 34 weeks of pregnancy can be treated at least several days before delivery with drugs called corticosteroids, which speed maturation of fetal lungs (8). Studies show this treatment reduces RDS, brain bleeds and infant deaths (8).
Birth defects cause about 20 percent of neonatal deaths (2). Babies with birth defects may be premature or full term. Sometimes parents learn about their baby’s birth defects before birth from prenatal tests, such as ultrasound, amniocentesis and chorionic villus sampling (CVS).
Ultrasound uses sound waves to take a picture of the fetus. It can help diagnose structural birth defects, such as spina bifida (open spine), anencephaly (brain and skull defect), and heart or kidney defects. In amniocentesis, the doctor inserts a thin needle through the abdomen to obtain a small sample of amniotic fluid for testing. In CVS, the doctor takes a tiny sample of tissue from the developing placenta, either using a thin tube that is inserted through the vagina or a needle that is inserted through the abdomen. Amniocentesis and CVS are used to diagnose chromosomal abnormalities, such as Down syndrome, and many genetic birth defects.
Other causes of neonatal death include problems related to:
What are the most common causes of neonatal death? Premature birth (before 37 completed weeks of pregnancy) is the most common cause of neonatal death. Prematurity and its complications cause about 25 percent of neonatal deaths (2). The later a baby is born, the more likely he is to survive. Almost 30 percent of babies born at 23 weeks of pregnancy survive, while about 50 to 60 percent of babies born at 24 weeks, about 75 percent born at 25 weeks, and more than 90 percent born at 27 to 28 weeks, survive (3,4,5).
More than 12 percent of babies born in the United States each year are premature (6). The causes of premature birth are not thoroughly understood. Three groups of women are at greatest risk for premature birth:
- Women who have had a previous premature birth
- Women who are pregnant with twins, triplets or more
- Women with certain uterine or cervical problems
In some cases, a pregnant woman may have health problems (such as high blood pressure), pregnancy complications (such as placental problems) or lifestyle factors (such as smoking) that increase her risk of delivering prematurely. More often, preterm labor develops unexpectedly in a pregnancy that had been problem-free.
Premature babies, especially those born at less than 32 weeks of pregnancy and weighing less than 3 1/3 pounds, may develop serious complications that can sometimes cause neonatal death. Some of these complications include:
- Respiratory distress syndrome (RDS): About 16,000 babies develop this breathing problem each year (7). Babies with RDS have immature lungs that lack a protein called surfactant that keeps small air sacs in the lungs from collapsing. Treatment with surfactant has greatly reduced the number of babies who die from RDS. However, about 825 babies a year die in the neonatal period due to RDS (1).
- Intraventricular hemorrhage (IVH): Premature babies sometimes develop bleeding in the brain. While mild brain bleeds usually resolve themselves with no or few lasting problems, severe bleeds often result in brain damage or even death.
- Necrotizing enterocolitis (NEC): Some premature babies may develop this intestinal problem, a serious inflammation of the bowel. It often resolves after treatment with antibiotics and, sometimes, surgery. However, some babies develop severe bowel damage and die.
- Infections: Premature babies have immature immune systems and sometimes develop serious infections, such as pneumonia (lung infection), sepsis (blood infection) and meningitis (infection of membranes surrounding the brain and spinal cord). In spite of treatment with antibiotics and antiviral drugs, some babies die.
While deaths due to prematurity are still too common, the outlook for premature babies is improving. Surfactant and other treatments are saving more premature babies after birth. And treatment before birth can sometimes prevent or lessen the complications of prematurity. Women who are likely to deliver between 24 and 34 weeks of pregnancy can be treated at least several days before delivery with drugs called corticosteroids, which speed maturation of fetal lungs (8). Studies show this treatment reduces RDS, brain bleeds and infant deaths (8).
Birth defects cause about 20 percent of neonatal deaths (2). Babies with birth defects may be premature or full term. Sometimes parents learn about their baby’s birth defects before birth from prenatal tests, such as ultrasound, amniocentesis and chorionic villus sampling (CVS).
Ultrasound uses sound waves to take a picture of the fetus. It can help diagnose structural birth defects, such as spina bifida (open spine), anencephaly (brain and skull defect), and heart or kidney defects. In amniocentesis, the doctor inserts a thin needle through the abdomen to obtain a small sample of amniotic fluid for testing. In CVS, the doctor takes a tiny sample of tissue from the developing placenta, either using a thin tube that is inserted through the vagina or a needle that is inserted through the abdomen. Amniocentesis and CVS are used to diagnose chromosomal abnormalities, such as Down syndrome, and many genetic birth defects.
Other causes of neonatal death include problems related to:
- Complications of pregnancy (such as preeclampsia, a pregnancy-related form of high blood pressure)
- Complications involving the placenta, umbilical cord and membranes (bag of waters)
- Infections
- Asphyxia (lack of oxygen before or during birth)
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