Investigation launched into abnormal spike in newborn baby deaths in Scotland

Control and warning limits are designed to flag up to public health teams when neonatal, stillbirth or other infant deaths are occurring at unexpectedly high or low levels which may not be due to chance.

Concerns have previously been raised about the potential impact of Covid on maternity services and maternal wellbeing, but it is the first time since the pandemic began that neonatal deaths have been so abnormally above average.

The neonatal mortality rate in September, at 4.9 per 1000 live births, was significantly above average

Although the rate fluctuates month to month, the figure for September - at 4.9 per 1000 live births - is on a par with levels that were last typically seen in the late 1980s.

Public Health Scotland (PHS), which is one of the bodies currently investigating the spike, said the fact that the upper control limit has been exceeded "indicates there is a higher likelihood that there are factors beyond random variation that may have contributed to the number of deaths that occurred".

READ MORE: Hospital admissions for under-fives soar amid spike in RSV cases

PHS said it is working with the Scottish National Neonatal Network, the Maternity and Children Quality Improvement Collaborative and the Scottish Government "to understand any possible contributing factors to the most recent infant mortality patterns, and to incorporate findings into existing prevention and improvement work".

Monthly figures on neonatal death rates are only available up to July 2017, but previously peaked at 3.7 per 1000 lives births in March 2020.

Annual statistics on neonatal mortality published by the National Records of Scotland show that it has been in steady decline for decades, falling from an average of 4.7 per 1000 live births in 1986-1990 to 2.2 per 1000 by 2016-2020.

READ MORE: Covid admissions falling rapidly in the over-75s amid 'booster effect'

Worldwide, the most common causes of neonatal death are infection, prematurity, and suffocation, but factors such as smoking during pregnancy or disruption to early intervention services including health visiting and midwifery also increase the risk.

PHS notes on its website that it "is important to monitor the levels of stillbirth and infant mortality during the Covid-19 pandemic, as they may be influenced by maternal health and wellbeing, by how maternity services are provided, and how people seek and interact with care".

A&E attendances were particularly high during September in the under-five age group, partly due to a surge in cases of RSV infection

Covid cases spiked to their highest recorded rate in September among the 0-14 age group, but there were no known Covid deaths in infants under one during that period

There is currently no detail on the causes of death involving the 21 infants who died in September. 

The period coincided with a surge in A&E attendances for children under five. The trend was largely blamed on an unseasonal spike in respiratory syncytial virus (RSV) which normally circulates in winter and can cause serious illness - especially in babies and toddlers.

It is clear, however, that none of the deaths were directly linked to Covid. 

Since the pandemic began in Scotland, there has been only one recorded Covid death - in December 2020 - in a baby aged under one. 

READ MORE: Pregnant women left exposed by mixed messages on vaccination

However, Dr Sarah Stock, an expert in maternal and foetal health at Edinburgh University, told the BBC that the virus could have led to an increase in infections in expectant mothers and premature deliveries as a result. 

Data for Scotland has previously highlighted a lower uptake of Covid vaccines in pregnant women than women of the same age, and Scotland experienced record Covid rates in late August into early September. 

Scotland saw a surge in Covid cases after schools returned and restrictions were lifted in August

Dr Stock said: "When pregnant women have Covid they can become seriously unwell, and in order to protect the mother and baby that can lead to pre-term deliveries.

"Pre-term delivery is the biggest driver of neonatal mortality.

"We also know that the pandemic has put a lot of pressure on health services and that could be having an impact."

A spokeswoman for the Scottish Government said: “Every death is a tragedy, and our thoughts are with everyone who is grieving the loss of a loved one.

“In 2020, Scotland recorded its lowest number of neonatal deaths. As the number of infant deaths is fortunately low, monthly mortality rates tend to fluctuate.

"We are working with PHS, the Scottish National Neonatal Network and the Maternity and Children Quality Improvement Collaborative to understand any possible contributing factors to ensure we continue to improve the care of the smallest and sickest babies in Scotland.”