Deaths of children in NSW in 2015: Natural causes

In 2015, 504 children aged from birth to 17 years died in NSW in 2015; a mortality rate¹ of 29.61 deaths per 100,000 children.

At the time of writing, a cause of death was known for 458 children. The majority of the children (370, 81%) died as a result of natural causes.

The table below describes the causes of death by each chapter of the International Classification of Disease 10
(ICD-10).

Trends in natural cause deaths

As shown in the figure below, there has been a significant decline in the rate of death of children in NSW from natural causes over the past 15 years, and the mortality rate in 2015 was the lowest annual rate in 15 years. The decrease in child deaths from natural causes has occurred nationwide and mostly reflects a decline in infant mortality, which is linked to factors such as advances in medical interventions and reductions in vaccine-preventable diseases through universal immunisation programs.2

While decreases in mortality rates are apparent, this has not been uniform:

• The mortality rate for male children was significantly higher than for female children. The rate of decline between the genders also differed. The natural cause mortality rate for female children showed a steady and continual decline over the 15-year period, whereas for male children, significant declines were only apparent in the last five years.
• In contrast to the consistent downward trend in natural cause deaths of non- Aboriginal and Torres Strait Islander children over the past 15 years, the average mortality rate for Aboriginal and Torres Strait Islander children from natural causes showed an increase between time periods 2001-2005 and 2006-2010 (from 35.2 to 37.42) before decreasing to 34.44 in 2011-2015.

Figure 1: Deaths due to natural causes: children aged 0-17 years by gender, 2001-2015

Leading natural causes of death: 2015

The following sections describe the six leading natural causes of death for children in 2015.

Conditions arising in the perinatal period

Perinatal conditions originate during pregnancy, or up to 28 days post-partum. They include conditions such as prematurity; respiratory and cardiovascular disorders; and maternal factors.

In 2015, 152 children died as a result of perinatal conditions, an infant mortality rate of 1.67 per 1,000 infants under the age of 12 months. More male infants (85, 56%) died of these conditions. All of the children who died were less than 12 months of age, and most of the children were younger than 28 days when they died (136, 89%); the majority (83) died on the day they were born.

In the last 15 years, perinatal conditions accounted for the deaths of almost one-third of the children (2,955) who died in NSW. The rate of death from perinatal conditions peaked in 2005. Since that time, the mortality rate has shown a continual and significant decline.

Congenital and chromosomal conditions

Congenital malformations, deformations and chromosomal abnormalities (‘congenital and chromosomal conditions’) include anatomical defects or developmental disorders that are present at birth,  such as heart and neural tube defects.

In 2015, 85 children died as a result of congenital and chromosomal conditions, a rate of 4.99. More male children (45, 53%) died from congenital and chromosomal causes than female children. The majority of the children (74, 87%) were less than one year old at the time of their death. More than two-thirds of these infants (58) died in first 28 days of life.

Over the last 15 years, congenital and chromosomal conditions accounted for the deaths of 16 percent (1,463) of the children who died in NSW. Advances in medical care and technology have improved long term survival rates among children with some types of major congenital defects. However, there has not been a corresponding downward trend in deaths from congenital and chromosomal conditions in NSW over the last 15 years.

Cancers and tumours (neoplasms)

The main types of cancers that caused the deaths of children in NSW over the last 15 years included leukaemia, and malignant tumours of the brain and central nervous system, thyroid and other endocrine glands, and bone and cartilage.

In 2015, 48 children died as a result of cancers and tumours, a rate of 2.82. More male children (27) died from cancers and tumours than female children (21). Cancers and tumours were the leading cause of death of children aged 5-14 years in NSW.

In NSW, cancers and tumours have consistently been a leading cause of death of children. Overall, the mortality rate from cancers and tumours declined only slightly between 2001 and 2004, and has shown no decline  since 2005

Deaths from nervous system diseases

Nervous system diseases include a broad range of conditions, such as epilepsy, cerebral palsy, muscular dystrophy and degenerative diseases of the brain.

In 2015, 37 children died from diseases of the nervous system, a rate of 2.17, which represents the highest annual rate since 2006. Almost half of the children (17, 46%) were infants. Twenty-one children were male and 16 were female.

The mortality rate of children from nervous system diseases showed significant decline between 2001 and 2006. From 2007, the rate of death from this cause has steadily risen.

Respiratory system diseases

Respiratory diseases include acute disease such as influenza³ and pneumonia, and chronic conditions such as asthma and bronchitis.

Fourteen children died from diseases of the respiratory system in 2015, a rate of 0.82. Half (7) of the 14 children who died from respiratory disease were under five years of age and half were of children ten years of age and older. More female (8) than male children died from respiratory diseases.

Over the last 15 years, 219 children in NSW died as a result of respiratory disease. While there has been year to year fluctuation in the rate of death from respiratory diseases, overall, the rate has not changed significantly since 2001.

Endocrine, nutritional or metabolic diseases

Endocrine and metabolic diseases include diabetes, cystic fibrosis and other types of rare metabolic or glandular disorders.

In 2015, 13 children in NSW died from metabolic disorders and two children from an endocrine disorder, a rate of 0.88. All except two of the 15 children who died were under 10 years of age. Nine of the children were female.

Between 2001 and 2015, 212 children in NSW died due to endocrine, nutritional or metabolic diseases. There has not been any marked change in the mortality rate from endocrine, nutritional and metabolic diseases, despite a degree of fluctuation from year to year.

Review of child deaths from infectious diseases in NSW 2005 – 2014

The CDRT commissioned the National Centre for Immunisation Research and Surveillance (NCIRS) to analyse data held in the NSW Child Death Register
in relation to deaths from infectious diseases in NSW. The report Child Deaths from Vaccine Preventable Infectious Diseases, NSW 2005-2014 is available on the Ombudsman’s website.

The review focused on diseases caused by a pathogen
(virus or bacterium) for which a vaccine is currently provided by the National Immunisation Program. The highest number of deaths was in infants under six months of age, with male children overrepresented.

Over half of the deaths were not considered preventable through immunisation, predominantly because the subtype was not covered by the vaccine, the relevant vaccine was not available prior to the time of the child’s death, or the child was too young to be eligible for vaccination.

However, twenty-three deaths were considered preventable or potentially preventable by vaccination, with influenza and meningococcal disease the most common causes of preventable or potentially preventable deaths.

Observations and recommendations

In regard to infectious diseases, the NCIRS review highlights that immunisation has been successful in dramatically reducing the number of child deaths from infectious diseases. However, deaths of children from potentially preventable infectious diseases continue to occur in NSW, particularly in young infants.

The NCIRS review identifies a number of strategies to prevent child deaths from infectious disease, including:

1.  Health practitioners should be aware of and promote recommendations in the Australian Immunisation Handbook, particularly:

• additional vaccines specifically recommended for high-risk children with medical conditions or compromised immune systems (such as influenza, invasive pneumooccal disease, meningococcal disease or Haemophilus influenzae type b disease). Mechanisms should be put in place so that opportunities to receive these vaccinations are not missed;
• influenza and meningococcal vaccinations for children in age or risk-groups for whom it’s recommended;
• pertussis (whooping cough) vaccination for household contacts of infants under 6 months;
• influenza and varicella vaccination for household contacts and carers of high-risk children;
• pertussis (whooping cough) and influenza vaccination for pregnant women;
• vaccination for international travel relevant to children, including hepatitis A and BCG vaccines;
• catch-up vaccination programs for children.

2. Facilities providing health or child care services for children who are at high risk of influenza or pertussis (whooping cough) infection, and facilities providing care to pregnant women, should take steps to provide comprehensive occupational immunisation programs for their workers as per the recommendations in the Australian Immunisation Handbook.

Details on vaccines provided free under the National Immunisation Program for specific age groups and particular at risk-groups are available on the Immunise Australia website. The Australian Immunisation Handbook is also accessible via this website.

The CDRT has recommended:

That NSW Health consider the observations and recommendations made in the report, Child Deaths from Vaccine Preventable Infectious Diseases, NSW 2005-2014 and advise the CDRT of existing or planned strategies to address these.

Notes

1. Crude mortality rate - deaths per 100,000 people under 18 years of age. For children aged less than 12 months, this report uses the Infant Mortality Rate, which is deaths of infants under 12 months per 1,000 live births.
2. Australian Institute of Health and Welfare (2015), Deaths, accessed from http://www.aihw.gov.au/deaths/age-at-death/ July 2016.
3. Influenza is an infectious disease, however, some types of influenza are classified as respiratory diseases under the International Classification of Diseases.

Since 1996, the CDRT has been responsible for reviewing and reporting to the NSW Parliament on all deaths of children aged less than 18 years in NSW. The CDRT maintains a register of child deaths in NSW. The Team consists of experts in child health, child protection and related areas, and representatives of key government agencies. The Convenor of the Team is the NSW Ombudsman, and Ombudsman staff provide support and assistance to the Team.

This page is a summary of key information contained in the NSW Child Death Review Team (CDRT) Child Death Review Report 2015.

Contact us for more information

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Sydney NSW 2000
Toll free (outside Sydney metro) 1800 451 524
Email CDRT@ombo.nsw.gov.au

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© State of New South Wales, November 2016
This publication is released under a Creative Commons license CC BY 4.0.