• Neonatology
• Mortality

As the first era of the Millennium Development Goals (MDGs) approaches the end and its successors the Sustainable Development Goals (SDGs) are launched, this is an appropriate time to reflect on reasons why such great progress has been made in some areas while so little has been achieved in others.

The case of perinatal mortality is perhaps the most baffling of them all. Though worldwide child mortality fell almost 50% from 90/1000 in 1990 (the benchmark year) to 46/1000 in 2013 (the most recent year for which data are available), there was almost no change in neonatal mortality. As a result, it has accounted for an ever-increasing proportion of the total child mortality and now contributes 45% or 2.9 million of the 6 million total. This, frustratingly, is the main reason the MDG 4 target of a two-thirds reduction in child mortality has not been achieved. Add to this the annual 2.6 million stillbirths and the picture becomes even more sobering.1

Though there is substantial knowledge of the main causes of neonatal death and effective …