Maternal and Neonatal Determinants of Admissions to the Neonatal Intensive Care Unit at Kirehe District Hospital, Rwanda

Abstract Background: Neonatal Intensive Care Unit (NICU) admissions demonstrate a big public health concern, particularly in low-resource settings. Understanding the determinants of these admissions is crucial for informing policies and interventions, as NICUs provide specialized care for newborns with life-threatening conditions, and identifying contributing factors can improve neonatal survival and health outcomes. Design and Methods: A cross-sectional study, conducted at Kirehe District Hospital from February to March 2024, examined maternal and neonatal factors influencing NICU admissions. Data was extracted from medical records and analyzed using descriptive statistics. Bivariate analysis with chi-square tests explored associations, while logistic regression identified independent predictors of NICU admission, adjusting for confounders. Statistical significance was set at p≤0.05 with 95% CIs to ensure robust and reliable findings on key maternal and neonatal determinants. Results: Among 340 neonates, 39.7% (135) were admitted to the NICU. Maternal factors were including mother aged ≥35 years (AOR=4.79 95% CI: 2.10–10.91), gestational diabetes (AOR=6.91, 95%CI: 3.15–15.17), maternal infection (AOR=3.54 95% CI: 1.58–7.95), multiple gestations (AOR=5.62), and caesarean delivery (AOR=2.51, 95% CI: 1.14–5.51). Neonatal factors included prematurity (AOR=8.52), LBW (AOR=6.79, 95% CI: 3.22–14.31), birth asphyxia (AOR=6.59, 95% CI: 1.73–25.10), RDS (AOR=5.61), and neonatal sepsis (AOR=4.31, 95% CI: 2.10–8.84), all significantly associated with NICU Admission. Conclusion: The study highlights the multifactorial determinants of NICU admissions, emphasizing the need for comprehensive interventions that strengthen antenatal care, enhance neonatal emergency preparedness, and ensure skilled facility-based deliveries to reduce avoidable admissions and advance neonatal survival in resource-constrained rural settings.