Definitions for causes of Neonatal Death Certification from Hospital data
Accidents/injuries: The cause of neonatal death can be clearly attributed to a severe accident or injury.
Congenital malformations: Only lethal or potentially lethal malformations that markedly increase mortality risk e.g. anencephaly, large meningomyelocoele, duodenal atresia, tracheo-oesophageal fistula or major cardiac malformations.
Prematurity: Gestation less than 33 weeks, and if gestation is not known or not reliable then birth weight <1.5 kg
Hyaline membrane disease / Respiratory distress syndrome : Presence of signs of respiratory distress (respiratory rate >60 per minute with either severe chest indrawing or grunting) in a preterm neonate with onset within 4 hours of birth. Chest radiograph shows poor lung expansion, reticulogranular pattern, ground glass opacity, and air bronchograms.
Intra-venticular haemorrhage : Radiological or ultrasonograhic evidence of intra-ventricular haemorrhage. If facilities to do this is not available, then spectrum of symptoms could be defined
Pulmonary haemorrhage : Frothy fresh bleeding from nose or mouth.
Birth asphyxia: APGAR Score<4 at 5 minutes or <5 at 10 minutes alone is enough if death occurs within 6 hours of birth. For deaths beyond 6 hours of age, in addition to the low APGAR score as above, presence of at least one of the following neurological signs of Hypoxic Ischemic
Encephalopathy (HIE) is mandatory: alteration in sensorium (hyper-alertness, jitteriness, lethargy or coma), seizures or hypotonia
Neonatal tetanus: A physician’s clinical diagnosis of the signs of tetanus (lock jaw, back arching, convulsions, spasms) beginning on day 3 or later in a baby who was initially normal for the first
2 days of life.
Pneumonia: In a neonate with respiratory distress (respiratory rate >60 per minute with either severe chest indrawing or grunting), presence of at least one of the following:
- clinical signs of sepsis (see list below)
- positive sepsis screen
- chest X-Ray suggestive of pneumonia.
[Note: If onset is before 72 hours of life, presence of one of the following - maternal fever (during labour or within 3 days after birth), foul smelling liquor or prolonged rupture of membranes (>18 hours) is also necessary]
Meningitis: Positive lumbar puncture as defined as any of the following: culture or bacteria seen on gram stain, >32 leucocytes/mm 2 in CSF with >80% PMNs

Sepsis: In a neonate with at least two of the following clinical signs of sepsis (fever or hypothermia, convulsions, not feeding well, no spontaneous movement, weak or absent cry, abdominal distension):
- Isolation of pathogen from blood: DEFINITE SEPSIS
- Absence of pathogen in blood culture but positive sepsis screen and clinical course suggestive of sepsis: LIKELY SEPSIS
- Absence of pathogen in blood culture and negative sepsis screen but clinical course suggestive of sepsis: POSSIBLE SEPSIS [Note: if onset is before 72 hours of life, additionally one of the following should be present - maternal fever, foul smelling liquor or prolonged rupture of membranes (>18 hours)]

Definitions for causes of Death Certification from Verbal Autopsy
Accidents/injuries: The cause of neonatal death can be clearly attributed to a severe accident or injury.
Congenital malformations: Only lethal or potentially lethal malformations that markedly increase mortality risk e.g. anencephaly, large meningomyelocoele, volvulus
Prematurity: Pregnancy lasted 7 months or less; or pregnancy lasted 8 months and the size of the baby was very small at birth.
Birth asphyxia: Baby did not cry or breathe immediately after birth, may have been given assistance to breathe. This history alone is enough if death occurs on the day of the birth. For deaths occurring after the day of the birth, presence of atleast one of the following starting on or before day 3 of life is also necessary with the above: convulsions, limp, or flaccid, unresponsive or unconscious.
Neonatal tetanus: Unable to open mouth after feeding well for the first days of life, has convulsions or spasms, beginning day 3 in a baby who was initially normal for the first 2 days of life.
Pneumonia: Fast breathing, chest in-drawing or grunting, starting after day 3 of life. If less than 3 days, maternal fever, foul smelling liquor with X- ray evidence of pneumonia
Sepsis: At least two of the following clinical signs of sepsis- fever, cold to touch, stopped feeding well, lethargic or unresponsive/ unconscious after a period of normal activity, abdominal distension.
Diarrhoea: Mothers reporting of loose stools
Meningitis: Convulsions AND fever or any one sign of sepsis.
Necrotisingentercolitis: Bleeding per rectum with abdominal distension after 1-2 days of life

List of Causes of Neonatal Deaths
Part: I ( Disease or Condition directly leading to death)
1.
Accident/ Injuries
2.
Congenital Malformations
3.
Prematurity (only if <33 weeks)
4.
Birth Asphyxia
5.
Tetanus
6.
Pneumonia
7.
Meningitis
8.
Diarrhoea
9.
Sepsis
10.
Other Specific condition*
11.
Unexplained neonatal death
*May not be possible to ascertain by verbal autopsy
(Other Significant Conditions)
Infant Conditions
1.
Pre-term (33-36 weeks gestation)
2.
Low birth weight
3.
Others
Maternal Conditions
1.
Multiple pregnancy
2.
Maternal disease existing before pregnancy (Diabetes/ Hypertension/
Epilepsy/ Hepatosis/ Renaldisease)
3.
Pregnancy induced hypertension (pre-eclampsia/ Eclampsia)
4.
Antepartum haemorrhage (Abruptio placentae/ Placenta praevia)
5.
Obstetric complications (Malpresentation/ Cord prolapse/ obstructed labour/ uterine rupture)
6.
Others