Timing and causes of neonatal deaths in India: a systematic review and meta-analysis

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OBJECTIVE: This review aimed to analyze the causes of neonatal mortality in India, explore the temporal distribution of death, and assess variations across causes and time intervals. INTRODUCTION: India accounts for approximately 25% of global neonatal deaths. Understanding when and why neonatal deaths occur is essential for designing and delivering context-specific interventions more effectively. ELIGIBILITY CRITERIA: Studies focusing on newborn deaths (within 28 days of birth) in India were eligible for inclusion. Observational studies, including cross-sectional, prevalence, and cohort studies published from database inception to April 1, 2025, in any language were considered for inclusion. METHODS: The review followed the approaches by PERSyst group and the JBI Manual for Evidence Synthesis . Studies were identified through searches in PubMed, ProQuest, and Scopus. Screening of the studies was done manually. Data were independently extracted using a predefined master sheet, and methodological quality was assessed using JBI critical appraisal tools. Findings were synthesized narratively, and pooled estimates were generated using random effects meta-analysis for overall timing of neonatal death and overall causes of neonatal death. RESULTS: A total of 32 studies comprising 14,681 neonatal deaths were included. Pooled estimates reported that 75% (95% CI: 68-81%) of deaths occurred in the early neonatal period (1 to 7 days) and 25% (95% CI: 20-30%) in the late neonatal period (8 to 28 days). Of all deaths, 36% occurred on the first day of life and 18% on days 2 and 3. Over 90% of deaths due to birth asphyxia and prematurity/low birth weight occurred within the first week, whereas sepsis was more evenly distributed across the early (45%) and late (52%) neonatal periods. Prematurity/low birth weight was the leading cause of death (31%). Over time, early neonatal mortality showed marginal decline, while late neonatal mortality slightly increased; deaths due to asphyxia and prematurity increased, whereas those from congenital anomalies, sepsis, and other causes showed modest reductions. CONCLUSION: The first 3 days of a newborn's life are the most critical, contributing to the majority of mortalities due to asphyxia, prematurity, or low birth weight. The study also reported cases of sepsis during early life. This study highlights the need to scale up evidence-based practices and interventions for the overall improvement of newborn survival. REVIEW REGISTRATION: PROSPERO CRD420251072864.

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Related topics: Global Maternal and Child Health · Maternal and Neonatal Healthcare · Neonatal Respiratory Health Research