title: Possible Prevention of Neonatal Death: A Regional Population-Based Study in Japan.
abstract: OBJECTIVE
  The neonatal mortality rate in Japan has currently been at the lowest level in the world. However, it is unclear whether there are still some potentially preventable neonatal deaths. We, therefore, aimed to examine the backgrounds of neonatal death and the possibilities of prevention in a region of Japan.
  
  
  METHODS
  This is a population-based study of neonatal death in Shiga Prefecture of Japan.
  
  
  RESULTS
  The 103 neonatal deaths in our prefecture between 2007 and 2011 were included. After reviewing by a peer-review team, we classified the backgrounds of these neonatal deaths and analyzed end-of-life care approaches associated with prenatal diagnosis. Furthermore, we evaluated the possibilities of preventable neonatal death, suggesting specific recommendations for its prevention. We analyzed 102 (99%) of the neonatal deaths. Congenital malformations and extreme prematurity were the first and the second most common causes of death, respectively. More than half of the congenital abnormalities (59%) including malformations and chromosome abnormality had been diagnosed before births. We had 22 neonates with non-intensive care including eighteen cases with congenital abnormality and four with extreme prematurity. Twenty three cases were judged to have had some possibility of prevention with one having had a strong possibility of prevention. Among specific recommendations of preventable neonatal death, more than half of them were for obstetricians.
  
  
  CONCLUSIONS
  There is room to reduce neonatal deaths in Japan. Prevention of neonatal death requires grater prenatal care by obstetricians before birth rather than improved neonatal care by neonatologists after birth.
authors: Department of Community Perinatal Medicine, Shiga University of Medical Science, Otsu, Japan. koshida@belle.shiga-med.ac.jp.
authors: Shigeki
authors: S
authors: Koshida
authors: Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan.
authors: Takahide
authors: T
authors: Yanagi
authors: Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan.
authors: Tetsuo
authors: T
authors: Ono
authors: Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan.
authors: Shunichiro
authors: S
authors: Tsuji
authors: Department of Community Perinatal Medicine, Shiga University of Medical Science, Otsu, Japan.
authors: Kentaro
authors: K
authors: Takahashi
mesh_terms: D002423:Cause of Death; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007564:Japan / Q000453:epidemiology; D008297:Male; D066087:Perinatal Death; D054238:Perinatal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology*
keywords: Neonatal death; cause; end of life care; population-based study; prevention