**1. Introduction**

The fourth Millennium Development Goal (MDG) was a two-third reduction in the mortality of children under the age of 5 years, which sub-Sahara African countries (including South Africa) failed to achieve this [1]. In 2015, 1 million children died within the first day of life, a further million in the first week of life and yet another 2.8 million in the first 28 days of life –

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

4.8 million of the almost 6 million children under the age of five years who died in 2015, died within the neonatal period [1]. Concentrating resources on newborns is therefore essential to further reduce childhood mortality.

The causes of neonatal mortality vary considerably among different units and different countries. The United Nations MDG 2015 report [1] states that "better data are needed for the post-2015 development agenda" and "real-time data are needed" to guide policy makers. Most data have a time lag of between 2 and 3 years before the policies are implemented. The MDGs formed the foundation of the so-called Sustainable Development Goals (SDG) [2]. The SDGs are less specific than the MDGs, but include health targets, one of which is to reduce both neonatal mortality and mortality of children under the age of 5 years.

Regular audits of neonatal mortality are required to identify the causes of death so that proper interventions can be implemented to reduce neonatal deaths. It is essential to have local data to address local health issues; transposing mortality data from another country will not necessarily solve local problems. This is particularly true when using data from a high-income country to address problems experienced in low- to middle-income countries (LMICS). A recent review of the mortality rates in neonatal intensive care units showed that the rate varied considerably between different countries [3]; the mortality rate was generally high, but greater in developing than developed countries. Issues such as the lack of antenatal care and inadequate health facilities are the causes of neonatal mortality in LMICS. A recent review from The Gambia [4] showed a high neonatal mortality rate – 35% of admitted neonates died. The important causes of neonatal death included lack of antenatal care, birth weight below 1500 g, hypothermia at birth, and delivery outside a teaching hospital.

Previous studies done in very low birth weight (VLBW) neonates – birth weight below 1500 g – at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) have shown that birth weight was the most significant predictor of survival [5, 6]. Resuscitation at birth, the use of nasal continuous positive airways pressure (NCPAP) and the mode of delivery were also important factors affecting survival. Survival of extremely low birth weight (ELBW) neonates was particularly low at CMJAH [7]. The provision of NCPAP to this category of neonates more than doubled their survival to discharge [6].
