Neonatal death

Loss and Grief

Key Points

The most common causes of neonatal death are preterm birth, low birthweight and birth defects.

An autopsy may help you find out why your baby died. You can choose whether to have an autopsy done.

Your health care provider or a genetic counselor may help you learn why your baby died and whether there’s a risk of the same problems in another pregnancy.

Getting counseling and support can help you cope with your baby’s death.

What is neonatal death?

Neonatal death is defined as the death of a baby in the first 28 days of life. Your baby’s health care provider can help you learn as much as possible about why this happened. 

Neonatal death happens in about 5.7 in every 1,000 births (less than 1 percent) each year in the United States. The rate is even higher for pregnant people who experience health disparities. For example:

  • Non-Hispanic Black: 10.8
  • Native Hawaiian or other Pacific Islander: 9.4
  • American Indian/Alaska Native: 8.2
  • Hispanic: 4.9
  • Non-Hispanic white: 4.6
  • Asian: 3.6

This is what is known as a health disparity, and it is unacceptable.  March of Dimes recognizes that racism and its effects are factors in the health disparities in pregnancy outcomes and babies' health. We must work together to bring fair, just and full access to health care for all moms and babies.

What are common causes of neonatal death?

The most common causes of neonatal death are:

  • Asphyxia. This is when a baby doesn’t get enough oxygen before or during birth.
  • Birth defects. These are health conditions that are present at birth.
  • Low birthweight. This is when a baby is born weighing less than 5 pounds, 8 ounces.
  • Preterm birth. This is when a baby is born too early, before 37 weeks of pregnancy.
  • Infections. Examples include sepsis (a blood infection), meningitis (an infection of the brain and spinal cord) or pneumonia (an infection of the lungs).
  • Intraventricular hemorrhage. This is bleeding in the brain. Most brain bleeds are mild and resolve themselves with no or few lasting problems. More severe bleeds can cause serious problems for a baby.
  • Necrotizing enterocolitis. This is a problem with a baby’s intestines. It can cause feeding problems, a swollen belly and diarrhea. 
  • Respiratory distress syndrome. This lung problem occurs most commonly in babies who are born before 34 weeks of pregnancy. Babies who have respiratory distress syndrome don’t have a protein called surfactant that keeps small air sacs in the lungs from collapsing.

If preterm birth is anticipated, Betamethasone, a steroid injection given over 24 hours to the pregnant person, will help the lungs develop quicker, protect the brain from hemorrhage and prevent the necrotizing enterocolitis. It does not always work but if there is time (usually 24 hours), the baby may have a better chance of survival.

Some pregnancy complications may cause a neonatal death:

  • Preeclampsia. 
  • Problems with the placenta, umbilical cord and amniotic sac. The placenta grows in the uterus and supplies the baby with food and oxygen through the umbilical cord. The amniotic sac contains the fluid that surrounds the baby during pregnancy.  If the membranes rupture and fluid is lost too early, the baby may deliver preterm or become infected and not survive.

What birth defects can cause neonatal death? 

The most common birth defects that cause neonatal death include: 

  • Heart defects. Some babies who have serious heart defects may not survive long enough to have treatment, or they may not survive after treatment. 
  • Lung defects. A baby may be born with problems in one or both lungs or may have lungs that aren’t fully developed. Birth defects or problems during pregnancy, such as not having enough amniotic fluid, can cause the lungs to develop incorrectly. Sometimes, these problems can cause a baby to die.
  • Genetic conditions. Genes are part of the cells in your body. They store instructions for the way your body grows, looks and works. A gene that’s changed from its regular form causes genetic conditions. Sometimes a baby’s genes can change on their own, and sometimes a baby will inherit a changed gene from one or both parents.
  • Neural tube defects. Some neural tube defects are more serious than others. If you’ve had a baby who had anencephaly, talk with your health care provider about taking folic acid to help prevent neural tube defects in your next pregnancy.  

Prenatal Testing: These tests can identify problems that exist before birth and can help pregnant people prepare.

Your health care provider can use prenatal tests to check your baby for birth defects before birth. Although these tests don’t prevent the condition, they do help pregnant people identify if there will be a problem with the baby.  These tests include:

  • Amniocentesis  at about 15-17 weeks to check the amniotic fluid for genetic changes
  • Chorionic villus sampling  at about 11-12 weeks to sample the area that the embryo implants
  • Ultrasound at 9-11 weeks to check neck thickness
  • Ultrasound  at 19-22 weeks to check that the baby’s anatomy is normal
  • Genetic Counseling to discuss family history and get information on testing available
  • Blood Testing:
    • Hemoglobin Electrophoresis to check blood for sickle cell and thalassemia
    • Cystic Fibrosis screen
    • QUAD screen at 15-19 weeks to identify birth defects
    • NIPPS screen: newer testing with multiple genetic information

Is an autopsy required?

Your baby’s health care providers can tell you what might have caused your baby to die. If you want more information, you may ask for a medical examiner to do an autopsy. An autopsy is a surgical exam that’s done after death to help find diseases, injuries and other causes of death. Not all autopsies provide enough information for doctors to understand what caused death. It’s your choice whether to have an autopsy performed. Most health insurance companies don’t pay for autopsies.

If you don’t want an autopsy to be done, your baby’s health care provider may be able to use other tests to find more information about why your baby died. These tests include genetic tests, X-rays and tests on the placenta and umbilical cord.

If the cause of your baby’s death was a birth defect, you can meet with a genetic counselor to learn more about it. You also can learn about the chances of having another baby who has the same birth defect. A genetic counselor is a person who is trained to help you understand about how genes, birth defects and other medical conditions run in families, and how they can affect your health and your baby’s health.

How can you deal with your grief?

Talking about your feelings may help you deal with the grief you feel about your baby’s death. There are people on the hospital staff that will help you and provide you with a picture, a lock of hair, and other memorial items you may want to have and they will be there for you.  Sometimes, it helps you to leave the hospital sooner if you are recovered from the birth. Your health care provider, nurse and social worker can be a source of comfort and support during this time. It is important to take the time to grieve your lost baby and to seek help from your partner, family, friends and professional therapists if needed. 

More information

Last reviewed: February 2024