Severe neonatal morbidity during first 27 postnatal days associated with childhood mortality: JAMA

A new study published in the Journal of American Medical Association showed that childhood mortality may be significantly increased by severe neonatal morbidity (SNM).

Even though it includes a range of diseases and is sometimes defined differently in different research, severe neonatal morbidity during the first 27 postnatal days has been recognized as a significant health indicator. Although newborn and early life death have been linked to severe neonatal morbidity, its longer-term relationships and cause-specific mortality are yet unclear. Thus, to investigate the relationship between SNM during the first 27 postnatal days and both cause-specific and all-cause mortality from infancy through late adolescence, this study was carried out.

A total of 2,098,752 live-born singleton neonates with gestational ages of 22 weeks or more, born between January 2002 and December 2021, who lived and did not migrate during the neonatal period were included in this population-based cohort research, which was carried out in Sweden. Data on mortality were gathered until March 2023, and from July 2024 to December 2024, the data was analyzed.

All-cause mortality and cause-specific mortality from 28 days to a maximum of 21.2 years were the main outcomes. Cox proportional hazards models were used to determine adjusted hazard ratios (aHRs) and 95% confidence intervals after controlling for maternal and baby variables. Additionally, a sibling-control analysis was conducted.

Of the 2,098,752 children that were part of the trial, 49,225 (2.4%) had a newborn diagnosis of SNM. A total of 3618 children passed away throughout the median (IQR) follow-up period of 10.5 (5.7-15.6) years. With an aHR of 5.92 (95% CI, 5.27-6.64), the death rate for children with SNM was 1.81 per 1000 person-years, whereas the rate for those without SNM was 0.13 per 1000 person-years.

A 17.67-fold increase in all-cause death after 28 days of life was linked to neonatal neurological disorders, which constituted the major morbidity (95% CI, 15.08-20.71). When compared to male children and children born at term, female children had higher aHRs for the link between SNM and all-cause death.

Until the earliest date of death, censoring because of emigration, or the end of follow-up, SNM was linked to an increased mortality risk from infections and diseases in the neurological, circulatory, respiratory, and metabolic systems. Sibling-control analysis revealed that family confounding had no effect on the relationships.

Overall, this cohort research showed that children with SNM who make it through the newborn period have a higher chance of dying as they become older. In addition to lowering mortality, efforts to guarantee early detection, minimize severe newborn morbidity, and offer long-term follow-up treatment may also assist guide conversations with families about prognosis and follow-up requirements.

Source:

Graham, H., Johansson, K., Persson, M., Norman, M., & Razaz, N. (2025). Severe neonatal morbidity and all-cause and cause-specific mortality through infancy and late adolescence. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2025.1873