Survival status and predictors of mortality among preterm neonates admitted to the neonatal intensive care unit at public hospitals of Harari region and Dire Dawa administration, eastern Ethiopia: Retrospective cohort study 2025

Abstract

BACKGROUND: The neonatal period is the most vulnerable time for an infant's survival, particularly for preterm neonates. Preterm birth is among the leading causes of neonatal mortality. Many neonatal complications can be prevented, but preterm birth remains a leading cause of admission, death, and long-term complications, highlighting the need for further research on outcome and survival disparities across populations and settings. Therefore, this study aimed to assess survival status and predictors of mortality among preterm neonates admitted to neonatal intensive care units at public hospitals in the Harari region and Dire Dawa administration, Eastern Ethiopia, from November 1, 2021 to October 30, 2024. METHODS: The hospital-based retrospective cohort study was conducted among preterm neonates admitted to the neonatal intensive care unit at public hospitals of the Harari region and Dire Dawa administration, Eastern Ethiopia. A simple random sampling technique was used, and data were extracted from neonates' medical records and registration formats using a structured checklist prepared in English. Descriptive statistics, life table, Kaplan-Meier curves, and Log-rank test were used to estimate and compare survival time. Predictors of mortality were identified using the Cox Proportional Hazard model. RESULTS: Out of 612 preterm neonates, 205 (33.5%; 95% CI: 29.76-37.39) died, corresponding to an incidence rate of 52.76 deaths per 1,000 preterm neonate-days (95% CI: 46.01-60.50), with a median survival time of 18 days. As multivariable cox-regression result, ≥ 4 antenatal care contact (AHR = 0.56; 95% CI: 0.36-0.89), receiving KMC (AHR = 0.16; 95% CI: 0.09-0.27), 5th minute APGAR score <7 (AHR = 1.80; 95% CI: 1.22-2.66), PNA (AHR = 1.55; 95 CI: 1.08-2.22), resuscitation with bag and mask at birth (AHR = 1.59; 95% CI: 1.10-2.29), RDS (AHR = 1.75; 95% CI: 1.22-2.51), born in non-cephalic presentation (AHR = 1.68; 95% CI: 1.12-2.53), and neonatal sepsis (AHR = 1.58; 95% CI: 1.09-2.28) were identified as significant predictors of preterm neonates mortality. CONCLUSION: The incidence of preterm neonatal mortality was high in this study. Adequate Antenatal care (ANC) and kangaroo mother care (KMC) significantly improved preterm survival, while low APGAR score, resuscitation with bag and mask, neonatal sepsis, PNA, and RDS were major predictors of preterm neonatal death. Emphasis should be placed on strengthening antenatal and perinatal care, along with early detection and management of identified neonatal complications.