Development of an Explainable Machine Learning Model to Predict Mortality Risk in Sepsis Patients: Insights From a Real-World Clinical Data.

The registration of births and deaths is a core public health function that supports population health assessment, international monitoring, and evidence‑based policy development [–]. Despite improvements in vital statistics systems, fetal deaths (FDs) remain difficult to measure accurately across settings, particularly in low‑ and middle‑income countries [–]. Challenges include variability in gestational age assessment, cause‑of‑death attribution, and legal or administrative frameworks governing the recognition and registration of pregnancy []. Substantial heterogeneity exists in how countries define and report FDs, often deviating from recommendations of the International Classification of Diseases (ICD) [–]. Under ICD-10, countries were allowed considerable flexibility in defining operational thresholds for FDs, resulting in indicators that are often not comparable across time or between countries []. ICD-10 recommended that published rates and ratios could use a denominator of either live births or total births (live births and FDs); additionally, it advised that fetuses weighing less than 500 g or less than 22 completed weeks of gestation should be excluded from the numerator []. Conversely, under ICD-11, the late fetal death rate is defined as the number of fetal deaths occurring at ≥ 28 completed weeks of gestation divided by total births (live births plus fetal deaths), multiplied by 1,000 []. In this study, the term “fetal death” is used as a general descriptor of all fetal deaths, while “late fetal death” refers specifically to deaths occurring at ≥ 28 completed weeks of gestation, consistent with ICD-11 criteria. The term “stillbirth” is not used to avoid ambiguity and ensure consistent terminology throughout the manuscript. The Every Newborn Action Plan (ENAP) implements the Global Strategy for Women’s and Children’s Health and aims to end preventable FDs ≥ 28 weeks, as well as to set the following goals: (1) all countries will reach the target late FD rate of 12 or less fetal deaths by 2030; and (2) all countries will reach the target late FD rate of 10 or less per 1000 total births by 2035.