When the 'dead' are still alive: Systemic failures in assessing neonates in Nepal.

Wrongful declaration of death in premature newborns continues in Nepal notwithstanding modern medical advances. We describe four cases of neonates who were wrongly declared dead and later found to be alive. This report aims to analyse the systemic failures that contributed to these outcomes which were identified over 6 years (2019-2025) through 'grey' literature. All these premature neonates were found alive hours later, some when enroute to cremation or burial. These cases highlight minimal or absent vital signs assessment before declaration of death was wrongly made and was shockingly negligent and a breach of the duty of care owed to the baby. In one case, death was declared by a nurse rather than a doctor in breach of minimum WHO standards and raises profound ethical and legal issues.