National trends in hospitalization, mortality, and health-service burden from selected perinatal conditions among infants in Ecuador: a retrospective ecological time-series study, 2012–2024

Perinatal disorders remain major causes of infant morbidity, mortality, and hospital resource use, but national assessments that integrate hospitalization, mortality, and service utilization are limited in Ecuador. A retrospective ecological time-series study was conducted using 13 annual national hospital discharge datasets and registered live-birth denominators for 2012–2024 and six annual mortality datasets for 2019–2024. Four International Classification of Diseases, 10th Revision categories were evaluated: disorders related to short gestation and low birth weight (P07), birth asphyxia (P21), respiratory distress of newborn (P22), and bacterial sepsis of newborn (P36). Hospitalization and mortality rates, ecological deaths-to-hospitalizations ratios, segmented trends, exploratory interrupted time-series estimates, negative binomial regression, deviations from prepandemic projections, hospital days, and acute disability-adjusted life years were assessed. The observed series contained 249,210 hospital discharges and 4,991 deaths among infants younger than 1 year. P22 generated the greatest burden, with 110,091 hospitalizations, 1,031,136 hospital days, 2,381 deaths, and 220,778.70 estimated DALYs. Its hospitalization rate increased from 25.90 to 41.57 per 1,000 registered live births, with a significant overall annual percent change (APC) of 3.15% (95% CI, 1.33%–5.00%). P21 had the highest ecological deaths-to-hospitalizations ratio (11.22%) and the only significant mortality increase (APC, 9.60%; 95% CI, 4.33%–15.13%; P=.007). P36 increased rapidly before a 2017 joinpoint and subsequently declined modestly; interrupted time-series estimates for 2020–2024 were therefore interpreted in the context of this pre-existing deceleration. Distinct perinatal conditions generated different patterns of frequency, mortality, and resource use. Respiratory distress dominated overall burden, whereas birth asphyxia showed the most concerning mortality trajectory. Linked national surveillance and condition-specific quality-improvement strategies are needed. Surveillance gap: National infant health surveillance can obscure clinically distinct patterns when morbidity, mortality, and resource use are assessed separately. Respiratory burden: Respiratory distress of newborn generated the greatest hospitalization, hospital-day, mortality, and estimated DALY burden. Complete national reanalysis: All 2012–2024 hospitalization years were analyzed as directly observed records, eliminating the need for pandemic-year imputation. Mortality signal: Birth asphyxia had the highest ecological deaths-to-hospitalizations ratio and the only statistically significant increase in mortality. Future direction: Linked birth, hospital, and mortality data are needed to distinguish changes in disease occurrence from referral, coding, and access-to-care effects.