Forensic Research Progress on Neonatal Deaths and Related Medical Disputes: A Comprehensive Review

Abstract

Medical disputes arise when patients or their families disagree with healthcare providers regarding adverse outcomes or their causation during medical care, subsequently demanding compensation, accountability, and initiating administrative or legal proceedings. Heightened public awareness of rights, coupled with insufficient understanding of medical complexities among families, frequently impedes consensus between healthcare providers and patients. This dynamic contributes to a rising annual incidence of medical disputes stemming from neonatal deaths, transforming it into a significant societal concern. The neonatal period represents a critical phase of adaptation to extrauterine life, characterized by incomplete organ development, poor environmental adaptability, and weak resistance. Any factor – medical error, birth trauma, or inappropriate nursing/feeding – can readily precipitate disease or death. The acute onset, rapid progression, and unpredictable outcomes of neonatal diseases further establish Neonatology and Obstetrics as high-risk specialties for disputes. In forensic practice, neonatal asphyxia remains a predominant cause of death. However, limitations in clinical asphyxia diagnosis render related fatalities particularly challenging in forensic examination and determination. The unique anatomy and physiology of neonates (e.g., organ immaturity, low immunity) increase vulnerability to threats like infection and asphyxia, resulting in high mortality rates. This vulnerability not only fuels the increase in disputes but also presents substantial challenges for forensic identification. Global data underscores the severity of neonatal mortality: WHO reports approximately 4 million neonatal deaths annually, accounting for 43% of under-five child mortality; 75% occur within the first week of life, and 50% within the first 24 hours. Blencowe H (2010) identified the primary global causes as prematurity and complications (35%), infection (27%), and intrapartum complications (23%). China exhibits regional disparities: economically developed areas mirror developed nations (birth defects and prematurity as leading causes), while less developed regions are dominated by asphyxia and infectious diseases. Current research predominantly focuses on clinical aspects of neonatal death; systematic studies from the perspective of medical disputes remain insufficient. Investigating the changing patterns of causes of death, mortality proportions at different time points, and triggers for disputes across time is crucial for clarifying contemporary dispute characteristics and providing insights for healthcare institutions to mitigate risks.