An "alarming" increase in deaths among newborn babies in Scotland could be linked to NHS staff shortages and widening health inequalities, an expert has said.

The latest quarterly statistics, published by the National Records of Scotland earlier this week, revealed that 41 neonatal deaths - where infants die within 28 days of birth - had been recorded in the three months to the end of September this year.

This put the neonatal mortality rate at a 15-year high of 3.4 deaths per live 1000 births.

It comes amid delays to the publication of an expert review investigating what led to two highly unusual spikes Scotland's neonatal death rates in September 2021 and March 2022.

The probe, announced by the Scottish Government in September 2022 and commissioned by Healthcare Improvement Scotland (HIS), was tasked with examining all reported neonatal deaths in Scotland from April 2021 until the end of March 2022 "to find out if there is anything that may have contributed to the increase".

The Herald: Monthly monitoring revealed that the 'control limit' (dotted red line) had been breached for the first time on record in September 2021 and again in March 2022, prompting a reviewMonthly monitoring revealed that the 'control limit' (dotted red line) had been breached for the first time on record in September 2021 and again in March 2022, prompting a review (Image: PHS)

It got underway in January - chaired by retired consultant neonatologist Dr Helen Mactier - and had been expected to take "no longer than six to nine months", with a report initially anticipated in the autumn.

However, a spokesman for HIS, which tracks the quality of public health services, said the report is now due early in the new year as “certain aspects have just taken a little bit longer than we expected”.

Dr Rosemary Townsend, a consultant obstetrician and research fellow at Edinburgh University, told BBC Good Morning Scotland that the latest figures for July-September this year looked "alarming" but that it was "important to take it in context" as a quarterly report.

She said: "It's important that we look at that and we examine it, but it is three months' worth of data.

"We do know that there is in the background this trend to an increase in neonatal death and that's what's being in a wider scale by the review that's being led by Dr Mactier.

"There are lots of potential causes and that's something that's going to be delved into in that review.

"People are concerned that there may have been a reduction in access to care, that some of the healthcare staffing shortages we're seeing are potentially impacting on quality of care.

"We are also noticing that people are becoming more medically complex in pregnancy and that might lead to an increase in pre-term births which is a significant driver of neonatal death, or there may be more difficulties experienced during birth itself.

"So there's a variety of things to explore but it's important to take it all in context and look at that wider picture."

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The Herald revealed how public health experts had first raised the alarm about neonatal deaths in late 2021, when monthly monitoring found that 21 babies had died within 28 days of birth during September compared to the nine which would have been expected based on pre-pandemic averages. 

The spike caused the neonatal mortality rate to breach an upper warning threshold known as the 'control limit', designed to alert Public Health Scotland to abnormal events which are unlikely to be due to chance.

The Herald: NHS staff shortages may be impacting on the quality of care for women, Dr Townsend saidNHS staff shortages may be impacting on the quality of care for women, Dr Townsend said (Image: Getty)

An internal investigation found no clear link to Covid infections in either mothers or babies, or an increase in premature births - all of which increase the risk of neonatal mortality. 

However, just six months later, in March 2022, the control limit was breached for a second time when 18 newborns died, leading the Scottish Government to order its review.

Dr Townsend said it was still possible that Covid is having an impact overall.

UK data up to 2021 indicate that roughly 12% of stillbirths and nearly 5% of neonatal deaths were associated with a mother who had had a Covid infection during pregnancy.

She said: "As a clinical obstetrician, I have cared for people who have unfortunately lost their babies because of a Covid infection - either during a pregnancy or shortly afterwards, so it certainly will have contributed to a small number of deaths but whether that's enough to have caused these sustained long-term trends is probably something we can't answer without looking into it in more detail."

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Dr Townsend added that significant health inequalities affecting expectant mothers in the most deprived areas and from ethnic minority backgrounds also need to be explored.

These women have been disproportionately affected by both Covid and cost of living pressures.

"It's definitely something we need to look at and examine in more detail," said Dr Townsend.

"It's really important to understand what's happened to someone in pregnancy and the environment they're living in because we know that that affects the risk of complications in pregnancy."

A spokesman for PHS said: “Every stillbirth and infant death is a tragedy for the families involved. We will continue to work with our partners to contribute towards reducing stillbirth and infant deaths as far as possible.”

Jenni Minto, the public health minister, said: “My thoughts and condolences are with all those who have lost a loved one.

"Scotland’s communities experience health, quality of life and life expectancy differently across our society.

"We’re focused on working with partners and taking preventative action to drive improvements in population health which will increase healthy life expectancy and reduce health inequalities.”