Causes of neonatal mortality in the European Economic Area and Switzerland: a WHO-based analysis and systematic review.

This study aimed to identify reported causes of neonatal death across the European Economic Area (EEA) member states and Switzerland as of 1 January 2010 (hereafter referred to as the European Region) and, where possible, examine the cause-specific distribution of neonatal deaths over time. We conducted a two-pronged analysis: (1) database analysis using WHO public datasets (2000-2021) for 28 countries in the European Region and (2) a systematic review and meta-analysis of pertinent records from PubMed, Embase, Web of Science, Scopus, Cochrane, and Google Scholar, which were comprehensively reviewed against inclusion criteria up to 10 August 2024, following PRISMA guidelines. The average neonatal mortality rate (NMRs) between 2000 and 2021 in WHO data was 2.63 per 1000 live births, with a significant decline (-0.074 per year) across the region. Prematurity (41.2%) and congenital anomalies (28.9%) were the most common registered causes of neonatal death; however, WHO data lacked etiological detail to reliably analyze cause-specific trends. The systematic review identified 41 eligible studies, of which 15 were included in meta-analyses. Pooled estimates showed that congenital anomalies and prematurity accounted for 30% (95% CI 17-46) and 31% (95% CI 18-49) of deaths, respectively. Among extremely preterm neonates, infections, respiratory, and cardiovascular disorders were the most common reported causes of death.      Conclusion: NMRs across the European Region are declining, with prematurity and congenital anomalies being leading causes of neonatal death. Current reporting frameworks lack granularity, and a wider adoption of standardized classification systems is critical to improving surveillance and data comparability, especially for preterm infants. What is Known: • Neonatal mortality rates have declined across Europe over recent decades. • There are considerable regional disparities in both causes and rates of neonatal death. What is New: • Prematurity and congenital anomalies each account for ~30% of neonatal deaths. • Greater use of standardized classifications of neonatal death causes is urgently needed.