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Retrospective analysis of neonatal deaths secondary to infections in England and Wales, 2013–2015
  1. Godwin Oligbu1,2,
  2. Leila Ahmed2,
  3. Laura Ferraras-Antolin2,
  4. Shamez Ladhani1,2
  1. 1 Immunisation and Countermeasures Division, Public Health England, Colindale, London, UK
  2. 2 Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
  1. Correspondence to Dr Shamez Ladhani, Immunisation and Countermeasures Division, Public Health England, Colindale, London NW9 5EQ, London, UK; shamez.ladhani{at}


Objective To estimate the overall and infection-related neonatal mortality rate and the pathogens responsible using electronic death registrations.

Design Retrospective analysis of national electronic death registrations data.

Setting England and Wales.

Patients Neonates aged <28 days.

Main outcome measures Overall and infection-related mortality rate per 1000 live births in term, preterm (28–36 weeks) and extremely preterm (<28 weeks) neonates; the contribution of infections and specific pathogens; comparison with mortality rates in 2003–2005.

Results The neonatal mortality rate during 2013–2015 (2.4/1000 live births; 5095 deaths) was 31% lower than in 2003–2005 (3.5/1000; 6700 deaths). Infection-related neonatal mortality rate in 2013–2015 (0.32/1000; n=669) was 20% lower compared with 2003–2015 (0.40/1000; n=768), respectively. Infections were responsible for 13.1% (669/5095) of neonatal deaths during 2013–2015 and 11.5% (768/6700) during 2003–2005. Of the infection-related deaths, 44.2% (296/669) were in term, 19.9% (133/669) preterm and 35.9% (240/669) extremely preterm neonates. Compared with term infants (0.15/1000 live births), infection-related mortality rate was 5.9-fold (95% CI 4.7 to 7.2) higher in preterm (0.90/1000) and 188-fold (95% CI 157 to 223) higher in extremely preterm infants (28.7/1000) during 2013–2015. A pathogen was recorded in 448 (67%) registrations: 400 (89.3%) were bacterial, 37 (8.3%) viral and 11 (2.4%) fungal. Group B streptococcus (GBS) was reported in 30.4% (49/161) of records that specified a bacterial infection and 7.3% (49/669) of infection-related deaths.

Conclusions Overall and infection-related neonatal mortality rates have declined, but the contribution of infection and of specific pathogens has not changed. Further preventive measures, including antenatal GBS vaccine may be required to prevent the single most common cause of infection-related deaths in neonates.

  • mortality
  • infectious diseases
  • immunisation
  • pathology

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  • Contributors SL conceived the work; GO, LA, LF-A and SL extracted and analysed the data. GO wrote the first draft of the manuscript. All authors contributed to the discussion and edited the manuscript. All authors approved the final submitted version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Public Health England has legal permission, provided by Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002, to process patient confidential information for national surveillance of communicable diseases.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.