Abstract
Introduction
Despite continued advances in prenatal and neonatal care, birth asphyxia and intrauterine hypoxia remain significant causes of preventable mortality in the early neonatal period. Fetal, maternal, and health-system factors influence outcomes immediately after birth. This study aims to analyze trends in infant mortality related to these conditions and examine differences across demographic groups.
Methods
Data on infant mortality related to intrauterine hypoxia or birth asphyxia were obtained from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database. Crude mortality rates (CMR) were utilized to calculate annual percent change (APC) and average annual percent change (AAPC) using the Joinpoint Regression Program. Analyses were conducted and stratified by sex, race/ethnicity, urban/rural classification, and United States (US) census region.
Results
A total of 28,500 infant deaths between 1999 and 2023 related to birth asphyxia and intrauterine hypoxia were identified. The overall CMR decreased significantly over this period. Both females and males demonstrated significant decreases in CMR, with AAPCs of -0.90* (95% CI−1.42 to−0.41) and−1.18* (95% CI -1.61 to−0.79), respectively, with male neonates consistently having a higher CMR than females. The CMR significantly decreased in all racial/ethnic groups except NH Asian or Pacific Islander infants. The NH White group showed the greatest decrease in CMR, while the NH Black or African American group consistently had the highest CMR. The Midwest showed the largest decrease in CMR with an AAPC of −1.69* (95% CI−2.54 to−0.85). The CMR also significantly declined in both urban and rural populations, with AAPCs of −1.81* (95% CI−2.42 to−1.26) and −1.50* (95% CI−2.24 to−0.76), respectively.
Discussion
Intrauterine hypoxia and birth asphyxia remain notable causes of neonatal mortality. After early declines, mortality rates have plateaued and modestly increased in recent years. Persistent disparities were observed, with higher mortality among male neonates, non-Hispanic Black neonates, and those in rural and Southern regions. These findings highlight persistent inequities in neonatal care, underscoring the need for targeted, equity-focused interventions.