Are infant mortality rates increasing in England? The effect of extreme prematurity and early neonatal deaths

BACKGROUND: Infant mortality has been rising in England since 2014. We examined potential drivers of these trends. METHODS: We used aggregate data on all live births, stillbirths and linked infant deaths in England in 2006–2016 from the Office for National Statistics. We compared trends in infant mortality rates overall, excluding births at <24 weeks of gestation, by quintile of SES and gestational age. RESULTS: Infant mortality decreased from 4.78 deaths/1000 live births in 2006 to 3.54/1000 in 2014 (annual decrease of 0.15/1000) and increased to 3.67/1000 in 2016 (annual increase of 0.07/1000). This rise was driven by increases in deaths at 0–6 days of life. After excluding infants born at <24 weeks of gestation, infant mortality continued to decrease after 2014. The risk of infant death was 94% higher in the most versus least deprived SES quintile, which reduced to a 55% higher risk after adjusting for gestational age. CONCLUSIONS: The observed increase in infant mortality rates since 2014 is wholly explained by an increasing number of deaths at 0–6 days of age among babies born at <24 weeks of gestation. Policies focused on improving maternal health to reduce preterm birth could substantially reduce the socio-economic gap in infant survival.