title: The changing profile of infant mortality from bacterial, viral and fungal infection over two decades.
abstract: OBJECTIVE
  Infection is an important cause of neonatal and infant mortality. We evaluated changes in infant deaths from infections from 1988 to 2008 in the North of England.
  
  
  METHODS
  We interrogated a population-based survey and reviewed infant deaths from infection. Proportional contribution to deaths, pathogens identified and risk factors were analysed.
  
  
  RESULTS
  Thirteen percentage of 4366 infant deaths from a population of 704 536 livebirths were infectious. The absolute numbers of infant deaths from infection fell over time but the proportion of deaths from infection increased (12.1%, 13.6% and 14.9%). Significantly preterm infants were increasingly represented in successive epochs (14%, 24% and 38%). Infant mortality rate (IMR) from meningococcus and Group B Streptococcus (GBS) fell in the latest epoch, but there was a corresponding increase from Escherichia coli and candida.
  
  
  CONCLUSIONS
  This large study shows that infections have become proportionately more important causes of death especially in very preterm infants. Recent significant reductions in death from meningococcus and GBS are likely to represent successful achievements of vaccination and antibiotic prophylactic policies. Increases in IMR from E. coli may relate to GBS prophylaxis and increases in candida to the increase from preterm populations. Further efforts to understand these changing patterns and develop additional prevention and treatment strategies and vaccines remain an urgent priority.
authors.affiliation: Newcastle Neonatal Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK. eleri.williams@nuth.nhs.uk
authors.forename: Eleri J
authors.initials: EJ
authors.lastname: Williams
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Embleton
authors.forename: Mary
authors.initials: M
authors.lastname: Bythell
authors.forename: Martin P
authors.initials: MP
authors.lastname: Ward Platt
authors.forename: Janet E
authors.initials: JE
authors.lastname: Berrington
mesh_terms: D001424:Bacterial Infections / Q000209:etiology / Q000401:mortality*; D004739:England / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000209:etiology / Q000401:mortality; D008137:Longitudinal Studies; D009181:Mycoses / Q000209:etiology / Q000401:mortality*; D012307:Risk Factors; D014777:Virus Diseases / Q000209:etiology / Q000401:mortality*
keywords: Candida; Escherichia coli; Group B streptococcus; Infant mortality; Infection