Why Fewer Babies Are Dying From Birth-Related Causes — and the One Trend Going the Wrong Way

A new 24-year look at US government death records shows real progress for newborns, plus one rising risk worth watching

A large new look at 24 years of US government records on newborn deaths brings mostly good news: for almost every one of the leading medical causes of death in the first month of life, things have been getting better, year after year. But the same records point to one specific problem that has quietly been getting worse instead of better, and understanding both halves of that story can help families and clinicians know where real progress has been made and where attention is still needed.

Historical Context: A Problem Families Have Long Faced, and How Care Has Changed Around It

For generations, the earliest days of a baby's life have been the riskiest, and for just as long, families and clinicians have had only a fuzzy sense of exactly why. A single overall number — how many babies died in their first month — could tell you whether things were improving in general, but not which specific dangers were shrinking, which were staying just as dangerous despite decades of progress, or whether some overlooked problem might be quietly worsening underneath an otherwise reassuring trend line. That distinction matters to a parent: knowing your hospital's overall newborn survival statistics is reassuring, but it does not tell you what to actually watch for.

A newly published national analysis [1] set out to answer exactly that more detailed question, using US death records collected between 1999 and 2022 to rank the ten leading specific medical causes of newborn death and track whether each one was becoming more or less common over time. This kind of detailed accounting builds on decades of broader progress. Government tracking of US infant deaths has continued to show a long-term decline in how often babies die in their first year of life [2], and that improvement is part of a worldwide pattern: international researchers tracking child survival across the globe have documented a similar decades-long fall in newborn deaths, alongside continued gaps between countries and ongoing global goals for reducing newborn deaths even further by 2030 [3]. Much of the US progress traces back to specific, deliberate changes in how sick and early newborns are cared for. Hospitals across the country now follow an established system that matches each newborn's level of medical need to a hospital equipped to handle it — from routine newborn nurseries up to the most intensive newborn intensive care units, a system formalized in current national pediatric standards [4] that helps ensure the most fragile babies reach the right level of specialized care. At the same time, doctors caring for newborns with suspected serious infection now follow a standardized, carefully studied approach to deciding who needs testing and antibiotic treatment and who does not, laid out in a national clinical guideline [5]. What had been missing, before this new analysis, was a clear picture of whether all of these advances were paying off equally across every specific cause of newborn death, or whether some causes were being left behind.

The Research: Studying Every Newborn Death Recorded in the US Over 24 Years

This was not a clinical trial — no families or hospitals took part in any experiment, and no new medicine or procedure was being tested or compared. Instead, researchers examined an existing government database of every death certificate for babies who died in their first 28 days of life anywhere in the United States between 1999 and 2022, and identified which had an underlying medical cause connected to pregnancy or birth [1]. They deliberately excluded deaths caused by birth defects or genetic conditions, focusing on causes connected to pregnancy, labor, and the newborn period itself. For each of the ten most common causes, the researchers calculated how that cause's death rate changed, on average, each year across the 24-year span — an "annual average percent change." A "confidence interval" around that yearly change is simply a range showing how sure the researchers can be; if it includes zero, the apparent change could just be random year-to-year variation rather than a real trend.

Key Results: Most Causes Falling, One Cause Rising

Over the full 24 years, 283,696 newborns in the United States died from a cause connected to pregnancy or birth, and boys made up 56.2% (159,445) of these deaths. Ten specific causes accounted for about 8 out of every 10 of these deaths — 79.8% (226,323) in total — led by complications of being born too early or too small, which was both the most common cause and one that became meaningfully less common over the study period. Most of the other leading causes told a similarly encouraging story: complications involving the placenta or umbilical cord, bleeding in the newborn, oxygen shortage around the time of birth, collapsed lung tissue, bleeding in the lungs, and newborn breathing distress all became rarer year after year, some quite sharply — breathing distress, for instance, fell at one of the steepest rates in the entire study. The single fastest-improving cause of all was a lung condition called interstitial pulmonary emphysema, in which air leaks into the tissue around the lungs; deaths from it fell by more than 5% per year on average.

Two findings stand out as especially important for families to understand. The first is the one piece of genuinely concerning news in an otherwise hopeful study: deaths linked to slow fetal growth and malnutrition before birth — meaning a baby did not receive adequate nourishment in the womb, resulting in lower birth weight or size than expected — were the only cause among all those studied to become significantly more common over time, rising by close to 2% each year. Researchers do not yet fully know why, but this pattern connects to what is already known about the added health risks facing babies born smaller than expected for their stage of pregnancy [6], and it is exactly the kind of early warning sign that this kind of long-term tracking is designed to catch. The second notable pattern is that two causes — complications of pregnancy in the mother, and serious newborn bacterial infection (sepsis) — were essentially unchanged over the full 24 years, neither clearly better nor clearly worse, even though newborn infection treatment today follows a well-established national guideline [5]. That does not mean the guideline has failed; it means this particular cause of death has proven especially hard to move further, even with good, standardized care already in place.

A few additional patterns rounded out the picture, each described by the researchers as an association rather than a proven cause-and-effect relationship. Boys died from these causes somewhat more often than girls, which researchers connect to known biological differences in how quickly boys' lungs and immune systems mature before birth [7]. Babies born vaginally had a death rate from these causes about three times higher than babies born by cesarean section, a pattern consistent with earlier research linking the way a baby is delivered to the risk of birth injury [8] — though this study did not report the exact numbers behind that comparison, only that the difference was roughly threefold. Babies born outside a hospital setting appeared to face a higher risk from certain breathing-related causes, something the researchers connect to differences in how quickly a struggling newborn can be resuscitated and stabilized outside a hospital's specialized equipment and staff, echoing broader safety concerns that have been raised about planned births outside hospital settings [9]. Finally, the finding on newborn infection deaths, and a similar finding about a serious intestinal condition in premature babies called necrotizing enterocolitis (which stayed roughly stable, with only a very slight improvement), lines up closely with a separate research team that studied the same government records over a nearly identical time period and reached matching conclusions [10] — a reassuring sign that these particular findings are not a fluke of one research group's analysis.

Interpretation: What This Means, and What It Does Not

Put simply, most of the ways newborns have historically died from pregnancy- and birth-related causes have become rarer in the United States over the past 24 years, reflecting real, sustained progress in prenatal and newborn intensive care [4]. But "most causes are improving" is not the same as "every cause is improving," and this study's value lies in refusing to blur that difference. Newborn infection and pregnancy-complication deaths have essentially plateaued rather than continuing to fall, and the rise in malnutrition-related deaths is a genuine, statistically confirmed trend rather than noise — it deserves attention rather than being lost inside an otherwise reassuring headline. It is also worth being honest about the study's limits. Because it relies on death certificates, which record only one official cause per death, a baby who died with both extreme prematurity and a serious intestinal complication would be counted under only one of those two causes, understating how often problems occur together. The study also could not examine feeding or nutrition practices that might explain the rising malnutrition trend, so that finding points toward a question, not yet an answer. And because the data are national, this analysis cannot say whether these patterns look identical in every state or region.

For Families and What Researchers Are Working on Next

For a family with a baby in the hospital today, the most reassuring takeaway is the big picture: the leading causes of newborn death from pregnancy- and birth-related conditions have, on the whole, become substantially less common over the past generation, which reflects real advances in how premature and at-risk newborns are cared for. The most actionable takeaway is narrower and more specific: fetal growth and nutrition before birth is an area getting fresh research attention precisely because of findings like these, so a parent whose baby was smaller than expected for their stage of pregnancy should feel free to ask their care team directly about growth monitoring and nutritional support, both before and after birth. Researchers are now working to understand exactly why slow fetal growth-related deaths are rising even as almost everything else improves, with attention turning toward antenatal nutrition and how consistently it is tracked and supported during pregnancy [6]. Investigators are also looking more closely at whether the differences seen by sex, delivery method, and birth setting reflect something that can be acted on clinically, or whether they mostly reflect other underlying differences in risk. None of this is cause for alarm — it is exactly the kind of careful, ongoing tracking that allowed today's real progress to happen in the first place, and it is the same kind of tracking that stands the best chance of catching tomorrow's problems early, as part of the broader global effort to keep newborn deaths falling [3].

References

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  2. Ely DM, Driscoll AK. Infant Mortality in the United States, 2023: Data From the Period Linked Birth/Infant Death File. National Vital Statistics Reports. 2025;74(7). doi:10.15620/cdc/174592 ↩
  3. Sharrow D, Hug L, Liu Y, et al.; for the UN Inter-agency Group for Child Mortality Estimation. Global, regional, and national levels and trends in under-5, infant, and neonatal mortality during 1990–2024 with scenario-based projections to 2030: modelling study. BMJ. 2026;393:e088684. doi:10.1136/bmj-2025-088684 ↩
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  10. Kolluru S, Liao N, Haase K, et al. Epidemiological trends in infant mortality related to necrotizing enterocolitis. Frontiers in Pediatrics. 2026;14:1825909. doi:10.3389/fped.2026.1825909 ↩