Global landscape of neonatal disorders attributed to environmental and maternal risks over three decades

Neonatal disorders persist as a leading contributor to global child mortality. While particulate matter (PM_2.5), low birth weight (LBW), and short gestation (SG) are well-documented risk factors, comprehensive assessments of their population-attributable burdens remain critically lacking. We analyzed data from the Global Burden of Disease Study 2021 to assess the global, regional, and national burden of neonatal disorders attributable to PM_2.5 exposure, LBW and SG from 1990 to 2021, situating these risk factors within a comprehensive framework to enable direct comparison across domains. Outcomes included deaths and disability-adjusted life years (DALYs), disaggregated by sex, disease subtype, and Socio-demographic Index (SDI). In 2021, 81.01 % of the global neonatal deaths were linked to LBW and SG (1.48 million deaths), with an Estimated Annual Percentage Change (EAPC) in age-standardized rate (ASR) of -1.48 (95 % CI: -1.56 to -1.40) since 1990. PM_2.5 exposure was responsible for 27.18 % of neonatal deaths (496,966 deaths), with an EAPC in ASR of -1.53 (95 % CI: -1.63 to -1.43) since 1990. Preterm birth represented the highest burden of disease subtype. Males consistently experienced a higher burden across both risk factors. Regional disparities were observed, with South Asia bearing the highest burden and high-SDI regions such as Australasia reporting the lowest. Strong inverse correlations were observed between SDI and PM_2.5, LBW and SG-related neonatal mortality and DALYs. A temporary increase in ambient PM_2.5-attributable burden was noted between 2010 and 2014. Despite progress in reducing household PM_2.5 and improving neonatal care, ambient PM_2.5 continues to pose a significant threat, particularly in low-SDI regions. The high burden of LBW and SG underscores the need for targeted maternal health interventions. Comprehensive, region-specific strategies that address both environmental and maternal factors are essential to reducing neonatal mortality and achieving global health goals.