Neonatal Survival and Predictors of Mortality Among Neonates Admitted at Neonatal Intensive Care Unit in Ethiopia: A Prospective Cohort Study

Introduction Globally, neonatal mortality remains a significant challenge, with Sub-Saharan Africa bearing the highest burden. Ethiopia ranks among countries with the highest neonatal mortality rates, but limited data exist on timing and predictors of neonatal deaths in the study setting. Objective(s) To assess neonatal survival and identify predictors of mortality among neonates admitted to the neonatal intensive care unit (NICU). Methods A prospective cohort study was conducted on 504 neonates admitted to NICU. Adjusted hazard ratios (AHRs) with 95% confidence intervals (CIs) were calculated to evaluate associations between potential predictors and mortality. Results At study end, 23.6% (95% CI: 19.8, 27.4) of neonates died, with a mortality rate of 35.5 per 1,000 neonate-days. Neonatal survival declined from 90% on day 1 to 66% by day 28. Significant predictors of mortality included lack of antenatal care (ANC) (AHR = 3.09), failure to cry immediately at birth (AHR = 2.61), respiratory distress syndrome (AHR = 6.96), and meconium aspiration syndrome (AHR = 9.16). Conclusion Neonatal mortality remains high in the study setting. Strengthening maternal and neonatal care, especially ANC and institutional delivery, is vital to improve neonatal survival.