Trends in the patterns of mortality on neonatal units have been changed the last two decades, particularly in the case of fatal infection. The aims of this study were to examine patterns of neonatal mortality during a twenty-one year time span (1993 to 2013) at St George’s Hospital, London. We compared the following three time periods; 1993–1999, 2000–2006 and 2007–2013. The neonatal unit at St George’s is a regional centre that providing medical and surgical intensive care for south west London. Data was collected retrospectively using logs of patients that were admitted to the ward and the corresponding discharge summaries. Over the three epochs, the number of deaths halved (301–159–152), and this trend was seen whether inborn (173–108–80) or outborn (128–51–72). The biggest improvement in mortality was seen in the inborn preterm babies <30w (92–63–38), and the outborn term babies (44–16–19). The median age at death increased for babies <30 w (4days–9.5days–12.5days) The relative frequency of both necrotising enterocolitis (9%–13%–26%) and septicaemia (18%–20%–40%) as a cause of death increased. On closer examination, the numbers of NEC have increased (25–20–40), while sepsis has not altered significantly (47–32–55); of note, consent for post mortem also declined between each period from 32% to 25% to 21%. Our data are consistent with similar papers. It is likely that the increase in NEC reflects later mortality in preterm babies surviving longer.