Neonatal Deaths in a London Hospital: Maternal, Fetal, and Ethnic Risk Factors
Dr Matthew Millns FY2 – with thanks to Ms Sangeeta Agnihotri and the Bereavement midwife team
Objectives
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•To identify key maternal and foetal risk factors contributing to neonatal deaths at a London District General Hospital in 2023.
•To evaluate the use and timing of diagnostic and management strategies, including antenatal care pathways and genetic screening.
•To assess the impact of early antenatal interventions in pregnancies complicated by prematurity, chromosomal anomalies, and congenital malformations.
•To explore the role of ethnic disparities, particularly in relation to late antenatal booking and adverse neonatal outcomes.
•To contextualise findings within the framework of the NHS 10-year plan to address inequalities in maternity care.
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Study Design
•A retrospective case series analysing nine neonatal deaths managed at a London District General Hospital.
Core Focus Areas
•Evaluation of maternal and foetal risk factors
•Review of diagnostic pathways and analysis of management strategies prior to neonatal death.
National Benchmarks
•Findings were reviewed in the context of national targets for neonatal mortality reduction.
Health Inequality Lens
•Emphasis was placed on ethnic and socioeconomic disparities, aligning with national efforts to advance equity in maternity care.
Methods
•Reviewed medical records of nine women with maternal risk factors (e.g., advanced age, obesity, hypertension, consanguinity, late booking).
•Categorised neonatal deaths by cause: prematurity, chromosomal abnormalities, congenital defects, and infections.
•Analysed antenatal diagnostics: trisomy screening, foetal echocardiography, infection panels.
•Included postmortem reports for diagnostic confirmation.
•Incorporated MBRRACE-UK1 data showing increased risk among socioeconomically deprived ethnic groups.
Results
Neonatal Death Patterns
•7 / 9 deaths occurred in extreme preterm births (<28 weeks)
•4 cases involved Trisomy 13, 18, or 21 + congenital anomalies
•1 case due to congenital CMV infection
Maternal Risk Factors
•Obesity
•Hypertension
•Late antenatal booking
•These were more common in South Asian mothers
Ethnic & Social Disparities
•Late booking (Often due to language barriers, cultural norms and lack of early pregnancy awareness)
• Resulted in missed screening and intervention windows
Mortality Rate Comparison
•Local neonatal mortality rate (2024): 0.19%
•NHS 10-year plan target: 0.05%1
•The local rate is nearly 4× higher than the national target
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Conclusions & Recommendations
Key Conclusions
•Early antenatal care and timely intervention are critical to reducing neonatal deaths
•Late booking remains a major barrier — especially among ethnic minorities
•Ethnic and social inequalities continue to drive disparities in outcomes
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Strategic Recommendations
•Promote early booking as a priority across maternity services
•Implement personalised care pathways for high-risk and minority groups
•Improve engagement with ethnic minority families, especially South Asian communities
Proposed Actions
Awareness Campaign Suggestions
•Launch a community-based education campaign on early booking
•Produce a poster that can be distributed to key community sites.
•Ensure materials are:
➤ Multilingual
➤ Culturally sensitive
➤ Involve key family decision-makers (e.g., spouses, elders, community/religious leaders)
(Not yet Implemented)
References
•1 - MBRACE-UK Perinatal Mortality Report 2023
•NHS Saving Babies’ Lives Care Bundle v3
•NICE Guidelines CG62 Antenatal Care
