U.S. Neonatal Mortality Has Declined in Recent Years, Though Not For All Causes – MedPage Today

Report on U.S. Neonatal Mortality Trends and Sustainable Development Goals (SDGs) Implications

Overview of Neonatal Mortality Trends in the U.S.

Over the past two decades, neonatal mortality in the United States has generally declined; however, this trend was not uniform across all leading causes of death. A retrospective cohort study analyzing data from 1999 to 2022 revealed significant variations in mortality rates associated with different perinatal complications.

Key Findings on Causes of Neonatal Mortality

1. There were 283,696 neonatal deaths attributed to perinatal complications during the study period.
2. The top leading causes included:
   • Disorders related to short gestation and low birth weight
   • Maternal complications of pregnancy
   • Complications of placenta, cord, and membranes
3. Declines were noted in mortality from:
   • Interstitial emphysema and related conditions (Annual Average Percent Change [AAPC]: -5.40%)
   • Respiratory distress originating in the perinatal period (AAPC: -3.63%)
   • Short gestation and low birth weight (AAPC: -1.41%)
   • Complications of placenta, cord, and membranes (AAPC: -1.73%)
   • Atelectasis (AAPC: -3.40%)
   • Intrauterine hypoxia and birth asphyxia (AAPC: -2.05%)
   • Neonatal hemorrhage (AAPC: -1.69%)
   • Necrotizing enterocolitis of the newborn (AAPC: -0.66%)
   • Pulmonary hemorrhage (AAPC: -3.06%)
4. Mortality rates remained stable for:
   • Maternal complications (AAPC: -0.35%)
   • Bacterial sepsis of the newborn (AAPC: -0.24%)
5. Mortality due to slow fetal growth and fetal malnutrition increased annually by 1.91%, highlighting emerging public health challenges.

Implications for Sustainable Development Goals (SDGs)

The study’s findings have direct relevance to several SDGs, particularly:

• SDG 3: Good Health and Well-being – The decline in neonatal mortality aligns with targets to reduce neonatal deaths and improve maternal health. However, the rise in deaths due to fetal malnutrition indicates ongoing challenges in prenatal care and nutrition.
• SDG 2: Zero Hunger – Increasing mortality from fetal malnutrition underscores the need for enhanced nutritional support during pregnancy to ensure healthy fetal development.
• SDG 10: Reduced Inequalities – Disparities in neonatal outcomes, such as higher mortality rates in vaginal deliveries compared to cesarean sections and increased risks associated with births outside hospital settings, highlight inequalities in healthcare access and delivery management.

Recommendations for Healthcare Providers and Policymakers

• Enhance early identification and monitoring of fetal growth restriction through improved prenatal screening.
• Implement robust prenatal nutritional support programs to address fetal malnutrition and improve maternal health.
• Optimize delivery planning and management to reduce complications, particularly in vaginal births and non-hospital settings.
• Address healthcare disparities by ensuring equitable access to quality perinatal care across different populations and regions.

Study Methodology and Data Sources

The research utilized ICD-10 codes from the CDC’s Wide-Ranging Online Data for Epidemiologic Research (WONDER) database, covering neonatal deaths from 1999 to 2022. Mortality rates were stratified by sex, mode of delivery, birthplace, and age at death. Male infants accounted for 56% of deaths, possibly due to biological differences in lung development and immune response.

Limitations

• Inability to assess nutritional factors such as exclusive breastfeeding rates.
• Exclusion of congenital malformations and limitation to a single ICD-10 code per death, restricting capture of co-existing conditions.
• Data aggregation at the national level limited adjustments for state-level variations.
• Potential data inconsistencies due to transitions in birth certificate standards between 1999 and 2015.

Conclusion

While the overall decline in U.S. neonatal mortality reflects progress toward achieving SDG 3, the rise in mortality from fetal malnutrition and persistent disparities in care delivery indicate areas requiring urgent attention. Strengthening prenatal care quality, enhancing nutritional support, and addressing healthcare inequalities are critical steps to further reduce neonatal mortality and advance sustainable development objectives.

References

• Khan M, et al. “U.S. neonatal mortality from perinatal causes.” JAMA Pediatrics, 2025; DOI: 10.1001/jamapediatrics.2025.1710.

1. Sustainable Development Goals (SDGs) Addressed in the Article

• SDG 3: Good Health and Well-being – The article focuses on neonatal mortality, perinatal complications, maternal health, and prenatal care, which are central to ensuring healthy lives and promoting well-being for all ages.
• SDG 2: Zero Hunger – The rising mortality due to fetal malnutrition implies issues related to nutrition during pregnancy, linking to the goal of ending hunger and improving nutrition.
• SDG 10: Reduced Inequalities – The article mentions disparities in maternal care and prenatal nutrition, which relate to reducing inequalities in health outcomes.

2. Specific Targets Under the Identified SDGs

1. SDG 3: Good Health and Well-being
   • Target 3.2: By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births.
   • Target 3.1: Reduce the global maternal mortality ratio to less than 70 per 100,000 live births, addressing maternal complications of pregnancy.
   • Target 3.8: Achieve universal health coverage, including access to quality essential health-care services and safe, effective, quality, and affordable essential medicines and vaccines for all, which is implied in the need for improved prenatal care and delivery management.
2. SDG 2: Zero Hunger
   • Target 2.2: By 2030, end all forms of malnutrition, including achieving targets on stunted and wasted children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women, and older persons.
3. SDG 10: Reduced Inequalities
   • Target 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, or other status, which relates to addressing disparities in maternal and neonatal health outcomes.

3. Indicators Mentioned or Implied in the Article to Measure Progress

• Neonatal mortality rate (per 100,000 live births) – The article provides crude rates of neonatal deaths from various causes, which directly measure progress toward reducing neonatal mortality (SDG 3.2).
• Cause-specific mortality rates – Rates of deaths due to short gestation, low birth weight, maternal complications, fetal malnutrition, and bacterial sepsis are used to monitor specific health challenges.
• Annual Average Percent Change (AAPC) – Used to track trends in mortality rates over time, indicating whether progress is being made or if certain causes are increasing.
• Mode of delivery-related mortality rates – Comparison of neonatal mortality rates between vaginal and cesarean deliveries, which may indicate quality of delivery management.
• Sex-disaggregated mortality data – Male infants accounted for 56% of deaths, indicating the importance of sex-specific health indicators.
• Indicators related to prenatal nutrition and care quality – Although not directly measured, the article implies the need for indicators such as rates of fetal growth restriction detection, prenatal nutritional support coverage, and exclusive breastfeeding rates.

4. Table of SDGs, Targets, and Indicators

Source: medpagetoday.com