Background To determine the trend and causes of neonatal mortality in a large level Ⅲ neonatal intensive care unit in Shanghai during a 15-year period. Methods This is a retrospective, single-centered study. All neonates who died during the period from January 1, 1999 to December 31, 2013 at Children's Hospital of Fudan University were included. We extracted relevant clinical information from their medical records, analyzed neonatal mortality rate and the characteristics of these patients, and compared neonatal deaths between different periods and populations. Results Among a total of 50,957 admissions during the study period, there were 929 neonatal deaths. The neonatal mortality rate was 1.82％. Trends in neonatal mortality rate showed an increase in the period from 1.0％ in 2003 to 2.2％ in 2013. The main causes of neonatal mortality were complications of preterm birth (33.6％), congenital anomalies (21.3％), infections (12.6％), and birth asphyxia (9.1％). The proportions of complications of preterm birth (P < 0.001) and congenital anomalies (P = 0.018) increased yearly, while the proportions of birth asphyxia (P < 0.001) and infections (P < 0.001) decreased. Proportions of deaths caused by birth asphyxia (P = 0.005) and infections (P < 0.001) were both higher in the migrating population than in the permanent residents. Conclusions Neonatal mortality rate increased from 2003 to 2013 in our study. The proportion of preterm infants in neonatal deaths also increased within the same period. Complications of preterm birth were the main cause of neonatal mortality and the percentage increased year by year. Neonates in the migrating population appeared to be at a higher risk of death during the neonatal period compared to those in the permanent residents, and efforts should be made towards improving perinatal care to prevent infections and birth asphyxia in this vulnerable population.
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