Abstract: Objective To analyze the trend of neonatal mortality and the main causes of death in Huaihua,and to provide theoretical basis for reducing neonatal mortality in the city.Methods Based on Huaihua death information System of children under 5 years old,the status quo and causes of neonatal death in 2014-2018 were analyzed by relying on the evaluation of neonatal death.Result The number of neonatal deaths declined year by year,with the total mortality rate falling from 4.16 per thousand in 2014 to 2 per thousand in 2018,with a percentage decrease of 51.92%. Neonatal deaths in 2014-2018 accounted for 41.46% of deaths among children under 5 years of age,representing 58.71% per cent of infant deaths. The common diseases that lead to neonatal death were preterm low birth weight,birth asphyxia,congenital heart disease,pneumonia,other congenital abnormalities,accidental asphyxia,respiratory distress syndrome,sepsis. In 2014 and 2015,preterm birth and low birth weight was the first cause of death in newborns,since 2016,birth asphyxia has been the first cause of death. A total of 169 cases were reviewed in 5 years,122 experts were evaluated,of which 35(57.38%) were “avoidable”deaths,108(63.91%) were “creating conditions to avoid”death,and 26(15.38%) were“inevitable”deaths. Analysis of the causes of neonatal mortality,The main factor during pregnancy and childbirth was that medical staff failed to correctly identify high-risk infants and non-standard neonatal resuscitation in pediatrics(63.64%each),followed by the failure of pregnant women and their families to refer the infants,follow-up or return in time,accounting for 35.66%. The main factors in the neonatal period were the lack of identification of critically ill newborns by medical staff(84.62%),the refusal of treatment by family members(71.33%),the lack of regional treatment network for critically ill newborns(70.63%),the lack of regional treatment centers accounted for 68.53%,and the irregular use of antibiotics accounted for 32.24%.Conclusion It is necssary to strengthen neonatal resuscitation technical training to reduce neonatal mortality in Huaihua,focus on neonatal critical identification and treatment techniques,antibiotic standard use training,pay attention to doctor-patient communication skills,establish and standardize the city's critical neonatal referral network.