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Concern raised at further rise in infant and neonatal mortality rates

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There have been increases in both the infant and neonatal mortality rates in England and Wales for the second year running, continuing the reversal of a decreasing trend over recent decades.

Smoking, rising obesity and a lack of maternity staff were all cited by the Royal College of Midwives as factors that needed to be tackled to stop the rise.

“There were small increases in both the infant and neonatal mortality rates but these remain low in historical terms”

Vasita Patel

The infant mortality rate increased in 2016 to 3.8 deaths per 1,000 live births, compared with 3.7 in 2015, according to a report published by the Office for National Statistics yesterday.

The ONS attributed the rate increase to a 2.8% increase in the number of infant deaths in 2016 compared with 2015, along with the 0.2% decrease in the number of live births over this period.

Overall, there were 2,651 deaths in children aged under one year in England and Wales in 2016, compared with 2,578 in 2015 and 6,313 in 1986.

“The infant mortality rate has been following a downward trend since the 1990s, until 2015, where the rate began to increase,” stated the ONS report.

The ONS report also highlighted regional variations in the infant mortality rate. In 2016, the rate remained highest in the West Midlands region of England, with 6.0 deaths per 1,000 live births.

In contrast, it remained lowest in the East, with 3.1 deaths per 1,000 live births. Meanwhile, the infant mortality rate for Wales was 3.0 deaths per 1,000 live births, a 16.7% decrease from 2015.

“Any increase is a real concern and we must see more steps taken to reverse this”

Gill Walton

In addition, the ONS noted that infant mortality rates were higher in the most deprived areas compared with the least deprived areas in both England and Wales in 2016.

The infant mortality rate in the most deprived areas was 5.9 per 1,000 live births in England, whereas the infant mortality rate in the least deprived areas was 2.6 per 1,000 live births.

In Wales, the most deprived areas had the highest infant mortality rate, at 4.7 deaths per 1,000 live births, and the lowest rate was in one of the less deprived areas, at 1.4 deaths per 1,000 live births.

At local authority level, the highest infant mortality rate in 2016 was in West Dorset (11.8 deaths per 1,000 live births) in England, and Isle of Anglesey (11.2 deaths per 1,000 live births) in Wales.

As well as latest available infant mortality data, the ONS also published specific figures on the perinatal, neonatal, post-neonatal periods.

In 2016, there were 3,112 stillbirths and 1,515 deaths at age under seven days, giving a perinatal mortality rate of 6.6 deaths per 1,000 total births, compared with 6.5 deaths the previous year.

  • Perinatal – 6.5 (2015) 6.6 (2016)
  • Neonatal – 2.6 (2015) 2.7 (2016)
  • Post-neonatal – 1.1 (2015) 1.1 (2016)
  • Infant mortality rate – 3.7 (2015) 3.8 (2016)

The ONS also released statistics on twin deaths in multiple birth babies for 2015. It showed twins, triplets and more accounted for 14.4% of all neonatal deaths, compared to 13.9% in 2014 – despite multiple births only accounting for 3.2% of births.

Cancers remain the most common cause of death for children aged one to 15 years, accounting for 20.6% of deaths in 2016, according to the ONS report

Vasita Patel, from the Vital Statistics Outputs Branch of the ONS, said: “In 2016, there were small increases in both the infant and neonatal mortality rates in England and Wales from 2015 but these rates remain low in historical terms.

“These increases can be attributed to many risk factors, such as the mother’s country of birth, mother’s age at birth of child, birthweight and the parents’ socioeconomic status,” she said.

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Gill Walton

Gill Walton chief executive at the RCM, said: “Any increase is a real concern and we must see more steps taken to reverse this.

“The regional variations in rates are worrying,” she said. “Trusts and regions must look to other areas where there are improvements being made to see why they are not doing as well, and to learn from those areas so that the regional variations are lessened.

“There is no doubt that in areas of high depravation, infant death rates are higher and this is where services need targeted resource,” noted Ms Walton.

She said: “There is also a need to tackle some of the biggest factors influencing this including smoking in pregnancy and rising levels of obesity, both of which can have an impact on infant mortality.

“Whilst we cannot make a direct connection between staffing levels, pressures on our maternity systems and infant mortality rates, there is no doubt that an overworked and under-resourced services cannot deliver the safest and highest quality care,” she added.

“It is deeply concerning to see a rise in infant mortality rates for the second year running”

Caroline Lee-Davey

The charities Bliss and the Twins and Multiple Births Association (Tamba) called for NHS England’s Neonatal Critical Care Transformation Programme Review, which was originally due out in September 2017, to be “given urgent attention”.

Caroline Lee-Davey, chief executive of the premature and sick baby charity Bliss, said: “It is deeply concerning to see a rise in infant mortality rates for the second year running.”

She said it was “now more important than ever” that NHS England published its review to ensure services were “properly resourced in the future to improve outcomes for premature and sick babies”.

Last November, the government announced an ambition to halve rates of stillbirths, neonatal and maternal deaths and brain injuries occurring during or soon or after birth by 2025.

Meanwhile, a separate report warned yesterday that health outcomes for babies and young children in the UK were now stalling in several key areas like infant mortality and immunisation levels.

The country is also lagging behind most other high-income countries on mortality, breastfeeding and obesity rates, according to the Nuffield Trust and Royal College of Paediatrics and Child Health.

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