Clinical–radiological profile and risk factors for early mortality in preterm neonates with respiratory distress syndrome in Hoima, Western Uganda

Respiratory distress syndrome (RDS) is the leading cause of respiratory failure and neonatal mortality, particularly in preterm infants. Despite global advances in neonatal care, RDS remains a significant problem in low-resource settings such as Uganda, where limited evidence exists on clinical profiles, mortality, and associated risk factors. Although these advances have greatly reduced mortality in high-income settings, their limited availability in Uganda contributes to the continued high burden of RDS-related deaths. To determine the clinical-radiological profile, early mortality, and risk factors for mortality among preterm neonates admitted with RDS at Hoima Regional Referral Hospital. A prospective cohort study was conducted among 150 preterm neonates with clinically and radiologically confirmed RDS. Data on sociodemographic, clinical, and obstetric characteristics were collected using structured questionnaires and chest X-rays. Participants were followed for seven days to determine outcomes. Descriptive statistics summarized baseline characteristics, while Poisson regression identified independent predictors of mortality. Of the 150 neonates, 62.7% were male and 70.7% were born before 32 weeks of gestation. Tachypnea (84.7%) and intercostal/subcostal retractions (71.3%) were the most frequent clinical features, while ground-glass patterns were the predominant radiological finding. Twenty-nine neonates died within the first seven days, giving an early mortality rate of 19.3%. Independent predictors of mortality were delayed presentation beyond six hours of life (aRR = 1.72, 95% CI: 1.43-2.07, p < 0.001) and birth weight < 1.5 kg (aRR = 1.12, 95% CI: 1.02-1.22, p = 0.015). RDS contributes substantially to early neonatal mortality in Uganda. Prompt recognition, early referral, and improved neonatal care-particularly for very low birth weight infants-are critical to improving outcomes. Although not directly measured in this study, improving access to antenatal corticosteroids and respiratory support-well-established interventions-remains essential for broader improvement of RDS outcomes.