Incidence and predictors of early neonatal mortality among neonates admitted to neonatal intensive care units in public general hospitals in Northwest Ethiopia: a multicenter prospective cohort study

Early neonatal mortality remains a major public health concern in Ethiopia, particularly among high-risk neonates requiring intensive care. However, prospective evidence from general hospital settings is limited. This study aimed to determine the incidence and predictors of early neonatal mortality among neonates admitted to neonatal intensive care units in Northwest Ethiopia. A multicenter prospective cohort study was conducted in seven public general hospitals from April 11 to July 14, 2025. Neonates aged < 7 days were followed from NICU admission until death, discharge, or completion of seven days of life. Data were collected using structured interviews and chart reviews. Modified Poisson regression with robust variance was used to identify predictors of early neonatal mortality. Variables with a p-value < 0.2 in bivariable analysis were included in the multivariable analysis. Multicollinearity was assessed using the Variance Inflation Factor (VIF). Adjusted risk ratios (ARR) with 95% confidence intervals (CIs) were reported. Statistical significance was set at a p-value < 0.05. Of the 380 enrolled neonates, 369 (97.1%) were included in the final analysis. Most neonates (86%) were admitted within the first 24 h of life, and 55.6% were male. A total of 63 deaths occurred during follow-up, yielding a cumulative incidence proportion of 17.1% (95% CI: 13.2–20.9). Independent predictors of early neonatal mortality included prolonged rupture of membranes ≥ 12 h (ARR: 2.48; 95% CI: 1.58–3.88), perinatal asphyxia (ARR: 2.31; 95% CI: 1.42–3.75), prematurity (ARR: 2.11; 95% CI: 1.15–3.88), and early-onset neonatal sepsis (ARR: 1.92; 95% CI: 1.16–3.16). Early neonatal mortality remains high among general hospital-admitted neonates in Northwest Ethiopia and is strongly associated with preventable maternal and neonatal predictors. Strengthening obstetric care, neonatal resuscitation, and infection prevention strategies is essential to reduce mortality. However, these findings are specific to NICU-admitted populations and should not be interpreted as population-level estimates.