Q COSTARICA — In 2024, Costa Rica recorded an infant mortality rate of 10.3 deaths per 1,000 live births—the highest the country has seen in two decades.
This uptick has sparked concern within the health community, especially since most of these deaths—about 75 percent—happen during the first 28 days of a newborn’s life.
According to Dr. Felipe Segreda, neonatologist and coordinator of Neonatal Resuscitation at the University of Medical Sciences (UCIMED), there is no single cause to explain the increase.
“This is the first time in the last 20 years that we have exceeded 10 per 1,000 live births. There is no single cause for the increase in infant mortality. It is multifactorial,” he noted.
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The data comes from the National Institute of Statistics and Censuses (INEC), which compiles and publishes monthly birth and death indicators in the country.
Extreme Prematurity
According to Segreda, extreme prematurity is currently the leading cause of mortality in the country. These include babies born before 28 weeks of gestation and weighing close to or less than 1 kilogram.
“75% of all deaths in the first year occur in the first 28 days of life. The most common cause is extreme prematurity,” he explained.
Other causes during this period include perinatal asphyxia (lack of oxygen during birth) and respiratory complications, which primarily affect premature infants.
In addition, deaths after the neonatal stage include congenital malformations and infections, although in smaller numbers.
Lack of specialists
The expert also stated that one of the factors influencing this increase is the decrease in the availability of neonatologists in public hospitals, especially during on-call shifts.
“There are fewer and fewer neonatologists caring for extremely premature babies. On-call shifts are often left to pediatricians or general practitioners, and this greatly limits the management of these babies,” he warned.
“During the pandemic, staff training was halted, and there was a lot of turnover. Training, primarily in neonatal resuscitation, was diminished, and this affected the training of those who care for this very delicate population,” the doctor emphasized.
High hospital-acquired infections
Meanwhile, another factor of concern is the high rate of nosocomial infections, that is, those acquired within hospitals.
“We have a very high rate of nosocomial infections in the country, and we have not implemented the appropriate interventions to reduce them in all neonatal intensive care units,” Segreda stated.
These infections are usually bacterial or fungal, affecting babies with weakened immune systems, especially those who are intubated or have vascular accesses.
“Good handwashing can prevent many of these infections,” he emphasized.
Prenatal Checkups
On the other hand, the doctor also emphasized the importance of prenatal and preconception checkups as part of prevention.
“A woman who enters pregnancy with good blood sugar, blood pressure, and weight control has a lower risk of premature birth or complications,” he recommended.
In addition, having adequate ultrasounds and specialists who identify risk factors is key to reducing prematurity.
Vaccination
The link between prematurity and respiratory complications means many babies remain vulnerable even after hospital discharge.
“Many premature babies who survive are predisposed to serious complications if they contract respiratory syncytial virus (RSV), influenza, or COVID-19,” the specialist warned.
For this reason, the doctor highlighted the importance of measures such as:
- RSV vaccination in pregnant women
- Administration of the monoclonal antibody palivizumab in premature babies under 32 weeks of age or with heart problems
- Reinforcement of influenza and COVID-19 campaigns
Vaccination is extremely important and plays a fundamental role, but unfortunately, rates have decreased, and we are seeing this reflected in hospital admissions at the National Children’s Hospital,” he stated.