Neonatal survival and mortality predictors among low-birth-weight neonates: A Retrospective cohort study from Suhul Hospital, northern Ethiopia

BACKGROUND: Neonates, defined as infants within the first 28 days of life, are especially vulnerable in conflict-affected settings. Globally, about 2.3 million neonatal deaths occur annually, with nearly 98% occurring in low- and middle-income countries. Despite several studies in this area, context-specific evidence remains limited, and knowledge and data gaps continue to hinder efforts to address health inequalities in resource-limited settings. This study, therefore, aims to evaluate neonatal mortality and identify its key predictors. OBJECTIVE: This study aimed to assess neonatal mortality and identify its associated risk factors. MATERIALS AND METHODS: A hospital-based retrospective cohort study was conducted among 329 neonates admitted between 2021 and 2023. Data were extracted from medical charts, registers, and maternal and neonatal history sheets. Kaplan-Meier survival curves and Cox regression models were used for analysis. Log-rank test and proportional hazards assumption were evaluated. Predictors of neonatal mortality were identified using Cox proportional hazards regression model, with statistical significance set at p < 0.05. RESULTS: The overall neonatal mortality rate was 216 per 1,000 live births (95% CI: 190.5-241.5), with a median survival time of 52 days. Multivariable Cox regression identified respiratory distress syndrome (RDS) and delayed initiation of breastfeeding as significant predictors of neonatal mortality. RDS was associated with an increased risk of death [AHR = 2.00, 95% CI: 1.16-3.46]. Compared with breastfeeding initiated within one hour of birth, delayed initiation of breastfeeding was associated with a higher risk of mortality [AHR = 6.23, 95% CI: 3.03-12.82], whereas formula feeding showed a similar trend that did not reach statistical significance [AHR = 2.602, 95% CI: 0.835-8.10]. CONCLUSION AND RECOMMENDATIONS: Neonatal mortality in this study was substantially high. Delayed initiation of breastfeeding and respiratory distress syndrome were identified as significant predictors of neonatal death. Public health interventions should focus on addressing modifiable risk factors for neonatal mortality. Strengthening postnatal maternal health education, promoting early initiation of breastfeeding, and increasing community awareness are essential. In addition, prioritizing respiratory distress syndrome management through effective infection prevention and control measures, quality neonatal care, and timely access to oxygen and surfactant therapy could enhance neonatal survival.