The changing profile of infant mortality from bacterial, viral and fungal infection over two decades

ABSTRACTAim: Infection is an important cause of neonatal and infant mortality. We evaluatedchanges in infant deaths from infections from 1988 to 2008 in the North of England. Methods: We interrogated a population-based survey and reviewed infant deaths frominfection. Proportional contribution to deaths, pathogens identified and risk factors wereanalysed. Results: Thirteen percentage of 4366 infant deaths from a population of 704 536livebirths were infectious. The absolute numbers of infant deaths from infection fell overtime but the proportion of deaths from infection increased (12.1%, 13.6% and 14.9%).Significantly preterm infants were increasingly represented in successive epochs (14%,24% and 38%). Infant mortality rate (IMR) from meningococcus and Group BStreptococcus (GBS) fell in the latest epoch, but there was a corresponding increase fromEscherichia coli and candida. Discussion: This large study shows that infections have become proportionately moreimportant causes of death especially in very preterm infants. Recent significant reductionsin death from meningococcus and GBS are likely to represent successful achievements ofvaccination and antibiotic prophylactic policies. Increases in IMR from E. coli may relate toGBS prophylaxis and increases in candida to the increase from preterm populations.Further efforts to understand these changing patterns and develop additional preventionand treatment strategies and vaccines remain an urgent priority.INTRODUCTIONDespite medical advances data suggest that infectionscontinue to have a significant impact on neonatal andinfant mortality even in developed countries (1,2). Deathcertificate studies in the United Kingdom (UK) (3,4)highlight the total burden and the large number of causesof infections on neonatal and infant mortality. However,detailed clinical data that might help focus efforts atreduction in cases are currently lacking.Data currently suggests that all-cause neonatal and infantmortality rates have steadily decreased in the UK in the last25 years. A proportion of these reductions are accountedfor by changes in vaccine preventable diseases particularlymeningococcus, Haemophilus influenzae type b and pneu-mococcus (5), but there is little data available describinghow all-cause infectious neonatal and infant mortality rateshave changed in this time period. There are many factorsthat affect the observed epidemiological patterns includingchanges to immunization schedules, improvements indiagnostic techniques and medical management, and anincreasing preterm population, in part as a consequence ofincreasing survival of the most immature.There are few long-term population-based data describ-ing the epidemiology of infectious death in infancy. Weaimed to describe the contribution of infections to infantmortality in a well-defined population in the UK andexplore how this has changed over a 21-year period.METHODSWe used the Perinatal Mortality Survey (PMS) database,coordinated by the Regional Maternity Survey Office(RMSO) in the North of England. This well-validatedpopulation-based survey captures the death of all live-borninfants of mothers resident in the North East and NorthCumbria within the first post-natal year, including infantswho were born or died outside the region. Deaths are