Abstract
BACKGROUND: Infant and neonatal health is a critical indicator for assessing a country's well-being and development. This study aimed to systematically analyze the global burden, long-term trends, coronavirus disease 2019 (COVID-19) impactions and inequalities of neonatal disorders and individual causes between 2000 and 2021. METHODS: We collected global, reginal and national annual data of neonatal disorders and individual causes on incidence and mortality between 2000 and 2021. Estimated annual percentage changes (EAPCs) were used to assess long-term trends and the impact of COVID-19. Lorenz curve and concentration index (CCI) was performed to evaluate the inequalities of neonatal disorders across socio-demographic index (SDI) levels. RESULTS: In 2021, there were 27,062,768 new cases and 1,831,535 deaths of neonatal disorders globally. Between 2000 and 2021, the incidence rate of neonatal disorders declined from 23,112.05 to 20,916.69 per 100,000 live births (EAPC= -0.63%), while the global mortality rate declined from 2048.34 to 1415.59 per 100,000 live births (EAPC= -1.76%). Since 2000, neonatal preterm birth has consistently had the highest incidence rate (16,658.81 in 2021, EAPC = -0.47%) and mortality rate (571.69 in 2021, EAPC = -1.73%). South Asia and sub-Saharan Africa were identified as high-burden regions. Globally, the incidence rate of neonatal disorders declined before the COVID-19 pandemic but began to rise during the pandemic, whereas the mortality rate continued to decline at a faster pace than the pre-pandemic period. Additionally, between 2000 and 2021, global burden of neonatal disorders was concentrated in lower SDI countries, particularly in mortality rates. CONCLUSIONS: Although global progress has been made in reducing the burden of neonatal disorders, Sub-Saharan Africa and South Asia remain high-burden regions requiring particular attention. To reduce global and regional disparities, particularly in the post-COVID-19 era, governments and international organizations are supposed to implement evidence-based strategies, such as increasing investments in maternal and neonatal care, expanding neonatal intensive care capacity, enhancing workforce training, improving health information systems, and addressing social determinants through integrated, multisectoral approaches.