US Neonatal Mortality Rate: Unveiling the Perinatal Causes

TOPLINE:

The neonatal mortality rate in the US decreased from 1999 to 2022, with deaths from interstitial emphysema and related conditions showing the steepest decline, yet mortality from slow fetal growth and malnutrition rose by nearly 2% annually.

METHODOLOGY:

• A retrospective study was conducted to examine neonatal mortality rates from 1999 to 2022 using data sourced from CDC Wide-Ranging Online Data for Epidemiologic Research, with diagnostic codes used to identify the cause of death related to perinatal complications.
• The top 10 causes of neonatal death were identified based on cumulative frequency over the study period.
• Mortality rates were stratified by sex, delivery method, birthplace, and age at death.

TAKEAWAY:

• From 1999 to 2022, 283,696 neonatal deaths were reported owing to perinatal complications, with male neonates accounting for 56.2% of deaths. The top 10 causes accounted for 79.8% of the deaths.
• Disorders related to short gestation and low birth weight were the leading cause of neonatal deaths, with a crude rate of 102.10 per 100,000 live births. They were followed by deaths in newborns due to maternal complications of pregnancy and issues related to the placenta, cord, and membranes.
• Mortality from interstitial emphysema and related conditions showed a steep decline, followed by respiratory distress from the perinatal period, with annual average percent changes of -5.40% (95% CI, -6.20% to -4.64%) and -3.63% (95% CI, -4.45 to -3.00), respectively.
• Mortality from slow fetal growth and fetal malnutrition increased by 1.91% annually (95% CI, 0.46%-3.82%), whereas mortality due to maternal complications and bacterial sepsis in newborns remained stable.

IN PRACTICE:

“US neonatal mortality has generally decreased, likely due to medical advancements, improved prenatal care, and neonatal intensive care interventions.” the authors wrote. “Vaginal deliveries were associated with nearly three times the neonatal mortality rate of cesarean deliveries, potentially due to complications, such as birth trauma and prolonged labor.”

SOURCE:

This study was led by Muzamil Khan, MD, of the George Washington University School of Medicine and Health Sciences in Washington, DC. It was published online on June 23, 2025, in JAMA Pediatrics.

LIMITATIONS:

This study could not assess important nutritional factors, such as exclusive breastfeeding rates, which may influence malnutrition outcomes. It focused only on perinatal causes influenced by healthcare and excluded congenital malformations. Each death was assigned a single diagnostic code, limiting the capture of coexisting conditions.

DISCLOSURES:

No funding source or conflicts of interest were disclosed by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.