Prevalence and Causes Related to Neonatal Mortality in Hospitalized Infants in Ahvaz, Iran: During the COVID-19

Background: Despite global efforts to improve neonatal outcomes, many newborns still face severe health challenges within the first 28 days of life. Among approximately 130 million births annually, over 4 million neonatal deaths occur, primarily in developing countries like Iran. Methods: This retrospective hospital-based cohort study was conducted on all 441 infants admitted to the neonatal intensive care unit (NICU), pediatric ward, and emergency department at Abuzar Hospital of Ahvaz in 2020 - 2021 who died. Quantitative variables were summarized using means and standard deviations, and qualitative data using frequencies. Chi-square and one-way ANOVA tests were used to examine associations between variables and causes of death. A significance level of P < 0.05 was applied. Results: During this study, 441 neonatal deaths were recorded among the hospitalized children in Abuzar Hospital. The rate of mortality was higher in hospitalized boys than in girls (P < 0.050). The rate of mortality among hospitalized children was higher in natural births than in cesarean sections (P < 0.050). The most common causes of death in hospitalized children under 5 years were asphyxia at birth (38 cases), structural brain disorders (22 cases), structural cardiovascular anomalies (66 cases), structural gastrointestinal disorders (59 cases), congenital metabolic diseases (28 cases), respiratory failure (153 cases), and sepsis (75 cases). Infants with congenital heart anomalies died significantly earlier than others. No statistically significant associations were found between mortality causes and variables such as gender, parental consanguinity, maternal comorbidities, delivery type, blood group, and maternal age. However, NICU admission and prematurity were significantly associated with higher mortality across all causes (P < 0.001). Conclusions: Neonatal mortality remains high, with respiratory failure being the leading cause. This highlights the need for improved care strategies for high-risk neonates, particularly those with respiratory complications.