Newborn Health and Child Mortality Across England

IMPORTANCEAlthough the immediate impact of neonatal illness is well recognized, its wider andlonger term outcomes on childhood mortality and the role of specific illnesses across childhoodare unclear.OBJECTIVETo investigate how many deaths in childhood are associated with neonatal illness andthe underlying conditions of the children who died.DESIGN, SETTING, AND PARTICIPANTSThis population-based cohort study of children who diedbefore age 10 years in England between April 1, 2019, and March 31, 2021, used data from theNational Child Mortality Database. Data analysis was performed from September 2022 to May 2023.EXPOSUREChildren who received care in a neonatal unit after birth plus those who died in the firstday of life, before admission to a neonatal unit, were considered to have likely neonatal illness.MAIN OUTCOMES AND MEASURESThe primary outcome was the relative risk (RR) of dying,stratified by likely neonatal illness and specific neonatal conditions. Comparisons were made usingthe chi 2or likelihood ratio test, as appropriate.RESULTSA total of 4829 children were included (median [IQR] age at death, 28 [2-274] days; 2606boys [54.8%]; 2690 White children [64.0%]). Overall, 3456 children who died (71.6%) had evidenceof likely neonatal illness. Children with neonatal illness were more likely to die before their tenth birthday than those without evidence of neonatal illness (RR, 13.82; 95% CI, 13.00-14.71). The estimated population-attributable risk fraction for neonatal illness among all deaths before age 10years was 66.4% (95% CI, 64.9%-67.9%). Children with preceding neonatal illness who died were more likely to have underlying behavioral or developmental disorders (odds ratio [OR], 3.31; 95% CI,2.47-4.42), chronic neurological disease (OR, 3.00; 95% CI, 2.51-3.58), and chronic respiratory disease (OR, 3.01; 95% CI, 2.43-3.73) than children without neonatal illness. CONCLUSIONS AND RELEVANCE In this cohort study, most children who died before age 10 yearshad some evidence of neonatal illness, and they died of a range of causes, including infections and sudden, unexpected, unexplained death. These findings suggest that improvements to perinatalmorbidity, an area with an existing evidence base for improvement, may have important impacts on child health across the next decade.