Brazil had an estimated infant mortality rate (IMR) of 30.4 per 1000 live births in 1998 which declined to 19.8 in 2008; in the latter 68% of all infant deaths occur in the neonatal period, with perinatal causes responsible for 80% of these deaths. This study aims to compare leading causes of infant mortality in Brazil in 1998 and 2008 using a detailed classification of perinatal causes based on similar potential strategy for care or prevention. All the four-digit ICD-10 codes from Brazilian infant deaths due to perinatal causes were collapsed into a modified Wigglesworth classification list which considered five defined groups: prematurity and related conditions, birth asphyxia, perinatal infections, maternal conditions and respiratory distress. Other selected groups of causes were congenital anomalies, nonperinatal infections (mainly pneumonia and diarrhoea), malnutrition and injury. IMR levels by cause were calculated by applying indirect demographic methods estimates to the proportional distribution of defined causes by age after redistribution of ill-defined causes. In 2008, mortality risks due to almost all causes decreased substantially, particularly when related to infections and malnutrition. Infections (nonperinatal) were the leading cause of death in 1998, with rate of 5.8 per 1000 live births. Although the IMR due to congenital anomalies was almost the same in 1998 and 2008, this cause ranked first as cause of death in 2008 together with prematurity. In conclusion, the reduction of IMR in Brazil implicates in a different distribution of causes of death and different challenges to the health system.
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