Flowchart of enrolled neonatal deaths from CHAMPS sites between December 2016 –December 2021, that had minimally invasive tissue samples (MITS) and consent only for verbal autopsy and clinical abstraction (Non-MITS) and included in the analysis.

Flowchart of enrolled neonatal deaths from CHAMPS sites between December 2016 –December 2021, that had minimally invasive tissue samples (MITS) and consent only for verbal autopsy and clinical abstraction (Non-MITS) and included in the analysis.</p

Proportion of infants and children who experienced each delay in “Three Delays-in-Healthcare” framework by age group, country site, sex, and site of death.

Proportion of infants and children who experienced each delay in “Three Delays-in-Healthcare” framework by age group, country site, sex, and site of death.</p

Immediate and antecedent causes of death when underlying cause was low birth weight and prematurity complications N9 (N = 404).

Immediate and antecedent causes of death when underlying cause was low birth weight and prematurity complications N9 (N = 404).</p

Characteristics of deaths enrolled in CHAMPS that occurred during the neonatal period, by age at death (2016–2021).

Characteristics of deaths enrolled in CHAMPS that occurred during the neonatal period, by age at death (2016–2021).</p

Recommendations for preventing deaths.

Each year, 2.4 million children die within their first month of life. Child Health and Mortality Prevention Surveillance (CHAMPS) established in 7 countries aims to generate accurate data on why such deaths occur and inform prevention strategies. Neonatal deaths that occurred between December 2016 and December 2021 were investigated with MITS within 24–72 hours of death. Testing included blood, cerebrospinal fluid and lung cultures, multi-pathogen PCR on blood, CSF, nasopharyngeal swabs and lung tissue, and histopathology examination of lung, liver and brain. Data collection included clinical record review and family interview using standardized verbal autopsy. The full set of data was reviewed by local experts using a standardized process (Determination of Cause of Death) to identify all relevant conditions leading to death (causal chain), per WHO recommendations. For analysis we stratified neonatal death into 24-hours of birth, early (1-</div

Pathogens identified in neonatal deaths in which infection was determined in the causal pathway, by age at death.

Pathogens identified in neonatal deaths in which infection was determined in the causal pathway, by age at death.</p

Immediate and antecedent causes of death when underlying cause was infection N6 (N = 254).

Immediate and antecedent causes of death when underlying cause was infection N6 (N = 254).</p

WHO ICD10 Perinatal Mortality underlying cause of death categories & specific underlying cause of death by age group.

WHO ICD10 Perinatal Mortality underlying cause of death categories & specific underlying cause of death by age group.</p

Neonatal deaths who had low birth weight in the causal pathway, by age at death.

Neonatal deaths who had low birth weight in the causal pathway, by age at death.</p

Relative proportion of neonatal deaths enrolled in CHAMPS, 2017–2021, attributed to the 5 most common categories of underlying causes (n = 826), overall and for deaths in the first 24 hours of life, early neonatal period (1–6 days), and late neonatal period (7–27 days).

Relative proportion of neonatal deaths enrolled in CHAMPS, 2017–2021, attributed to the 5 most common categories of underlying causes (n = 826), overall and for deaths in the first 24 hours of life, early neonatal period (1–6 days), and late neonatal period (7–27 days).</p