Neonatal death is when a baby dies in the first 28 days of life. If your baby dies this soon after birth, you may have many questions about how and why it happened. Your baby’s health care provider can help you learn as much as possible about your baby’s death.
Neonatal death happens in about 4 in 1,000 babies (less than 1 percent) each year in the United States. Non-Hispanic black women are more likely to have a baby die than women of other races or ethnicities.
What are common causes of neonatal death?
The most common causes of neonatal death are:
Premature birth. This is when a baby is born too early, before 37 weeks of pregnancy. Babies born too early may have more health problems than babies born on time.
Low birthweight. This is when a baby is born weighing less than 5 pounds, 8 ounces. Babies born too small may have more health problems than babies born at a healthy weight.
Birth defects. Birth defects are health conditions that are present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops or in how the body works.
Premature birth and low birthweight cause about 1 in 4 neonatal deaths (25 percent). Birth defects cause about 1 in 5 neonatal deaths (20 percent).
Other causes of neonatal death include:
Problems in pregnancy, like preeclampsia. This is a condition that can happen after the 20th week of pregnancy or right after pregnancy. It’s when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Signs of preeclampsia include having protein in the urine, changes in vision and severe headaches.
Problems with the placenta, umbilical cord and amniotic sac (bag of waters). The placenta grows in your uterus (womb) and supplies the baby with food and oxygen through the umbilical cord. The amniotic sac contains the fluid that surrounds the baby in the womb.
Infections, like sepsis. Sepsis is a serious blood infection.
Asphyxia. This is when a baby doesn’t get enough oxygen before or during birth.
Why are premature babies more likely to die shortly after birth than babies born on time?
Some premature babies may develop serious complications that can sometimes cause death. These complications include:
Respiratory distress syndrome (also called RDS). This is a breathing problem most common in babies born before 34 weeks of pregnancy. Babies with RDS don’t have a protein called surfactant that keeps small air sacs in the lungs from collapsing. RDS causes about 825 neonatal deaths each year.
Intraventricular hemorrhage (also called IVH). This is bleeding in the brain. Most brain bleeds are mild and resolve themselves with no or few lasting problems. More severe bleeds can cause serious problems for a baby.
Necrotizing enterocolitis (also called NEC). This is a problem with a baby’s intestines. It can cause feeding problems, a swollen belly and diarrhea. It sometimes happens 2 to 3 weeks after a premature birth. It can be treated with medicine and sometimes surgery. But in serious cases, it can cause death.
Infections. Premature babies often have trouble fighting off germs because their immune systems aren’t fully formed. Infections that may cause death in a premature baby include pneumonia (a lung infection), sepsis (a blood infection) and meningitis (an infection in the fluid around the brain and spinal cord).
What birth defects most often cause neonatal death?
The most common birth defects that cause neonatal death include:
Heart defects. Most babies with heart defects survive and do well because of medical treatments and surgery. But babies with serious heart defects may not survive long enough to have treatment, or they may not survive after treatment.
Lung defects. A baby may be born with problems in one or both lungs or with lungs that aren’t fully developed. Lung defects can happen when the lungs don’t develop correctly due to other birth defects or pregnancy problems (such as not enough amniotic fluid). Premature babies can have lung problems that cause neonatal death.
Genetic conditions. Genes are part of the cells in your body. They store instructions for the way your body grows, looks and works. Genetic conditions are caused by a gene that’s changed from its regular form. A gene can change on its own, or the changed gene can be passed from parents to children.
Brain conditions. Neonatal death can be caused by problems in the brain, like anencephaly. This is a condition called a neural tube defect (also called NTD) in which most of a baby’s brain and skull are missing. Babies with anencephaly may be stillborn (when a baby dies in the womb after 20 weeks of pregnancy) or die in the first days of life. If you’ve had a baby with anencephaly, talk to your health care provider about taking folic acid to help prevent NTDs in your next pregnancy.
Your health care provider can use prenatal tests (medical tests you get during pregnancy) to check your baby for birth defects before birth. These tests include:
Amniocentesis (also called amnio). In this test, your provider takes some amniotic fluid from around your baby in the uterus. The test checks for birth defects and genetic conditions in your baby. You can get this test at 15 to 20 weeks of pregnancy.
Chorionic villus sampling (also called CVS). This test checks tissue from the placenta to see if your baby has a genetic condition, like Down syndrome. You can get CVS at 10 to 13 weeks of pregnancy.
Ultrasound. This test uses sound waves and a computer screen to show a picture of a baby in the womb. It can help find birth defects like spina bifida, anencephaly and heart defects.
Do you need to have a post mortem on your baby?
Your baby’s health care providers can tell you what they know about what caused your baby to die. If you want more information, you may want to have an autopsy on your baby. An autopsy is a surgical exam of your baby’s body after death to help find the cause of death and any diseases or injuries. An autopsy gives information about why a baby dies in more than 1 in 3 cases. This information can be helpful to you if you think you may want to have another baby in the future. It’s your choice whether or not to have an autopsy on your baby. Families often have to pay for an autopsy, so ask your baby’s health care provider about payment. Some hospitals or states may pay for a baby’s autopsy; most health insurance companies don’t pay for one.
If you don’t want to have an autopsy, your baby’s health care provider may be able to use other tests to find more information about why your baby died. These tests include genetic tests, X-rays and tests on the placenta and umbilical cord.
If the cause of your baby’s death was a birth defect, you can meet with a genetic counselor to learn more about it. You also can learn about the chances of having another baby with the same birth defect. A genetic counsellor is a person who is trained to help you understand about how genes, birth defects and other medical conditions run in families, and how they can affect your health and your baby’s health.