Veronica N. E. Malange

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.

A bstract: Purpose: Despite considerable progress in reducing neonatal mortality, significant work remains. The regional differences in both the rates and causes of neonatal mortality, necessitates addressing this issue within a regional context. This study aimed to identify reported causes of neonatal death in the European Region and examine the cause-specific distribution of neonatal deaths over time. Methods: 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 various databases which were comprehensively reviewed against inclusion criteria up to 10 ^th August 2024, following PRISMA guidelines. Results: The average neonatal mortality rate between 2000–2021 in WHO data was 2.63 per 1,000 live births, with a significant decline (-0.074 per year) across the European Region. Prematurity (41.2%) and congenital anomalies (28.9%) were the most common registered causes of neonatal death; no detailed etiological breakdown was available. The systematic review identified 41 eligible studies; 14 could be included in meta- analyses. Pooled estimates showed that congenital anomalies and prematurity each accounted for 30% of deaths. Among extremely preterm neonates, infections, respiratory and cardiovascular disorders were the most common reported causes of death. Conclusions: NMRs across the European Region is declining (rapidly) with prematurity and congenital anomalies being leading causes of neonatal death. Current mortality reporting frameworks inadequately capture the diagnostic complexity of neonatal death causes. Adoption of detailed, standardized classification systems is critical to improving surveillance and data comparability, especially for preterm infants. W hat is K nown: Neonatal mortality rates have declined across Europe over recent decades. There are considerable regional disparities in both causes and rates of neonatal death. W hat is N ew: Prematurity and congenital anomalies each account for ∼30% of neonatal deaths. In extremely preterm infants, infections and cardiorespiratory disorders predominate. Greater use of standardised classifications of neonatal death causes is urgently needed.