Trends and Causes of Neonatal Mortality in Serbia, 1997-2016

Background: Regardless of the notable reduction in infant deaths worldwide over the last 30 years, the proportion of neonatal mortality in total child mortality is increasing. Aims: To perform a trend analysis of neonatal mortality in Serbia. Study Design: Descriptive observational study. Methods: Joinpoint regression was used to analyze neonatal mortality data for the years 1997 to 2016 that were obtained from the Statistical Office of Serbia. Results: The trend in the neonatal mortality rate decreased significantly by -5.6% (95% CI: -6.5 to -4.6) per year from 1997 to 2007, and by -2.6% (95% CI: -3.7 to -1.5) per year from 2007 to 2016. The neonatal mortality rate for certain conditions originating in the perinatal period decreased by -6.2% (95% CI: -7.5 to -4.9) per year during the years from 1997 to 2006, and by -1.9% (95% CI: -3.1 to -0.7) per year from 2006 to 2016. Among these conditions, disorders related to short gestation and low birth weight, not elsewhere classified, showed an upward trend by 8.5% (95% CI: 6.2 to 10.8) per year during the entire study period. From 1997 to 2016, a significant decrease in the neonatal mortality rate was detected in cases of congenital malformations, deformations, and chromosomal abnormalities, by -5.0% (95% CI: -6.1 to -4.0) per year. The neonatal mortality rate for cases of symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified, decreased by -8.1% (95% CI: -11.0 to -5.2) yearly. Conclusion: The neonatal mortality rate in Serbia decreased between 1997 and 2016, excluding deaths due to short gestation and low birth weight. Therefore, prevention of short gestation and low birth weight should be the highest public priority.