Incidence and Predictors of Mortality Among Preterm Neonates Admitted to Neonatal Intensive Care Units in Comprehensive Specialized Hospitals in Northeast Ethiopia: A Multi-Center Prospective Follow-Up Study

Abstract Background Despite numerous efforts, preterm mortality remains a significant public health burden in Ethiopia. Therefore, this study aimed to assess the incidence and predictors of preterm mortality among preterm neonates admitted to Comprehensive Specialized Hospitals in Northeast Ethiopia in 2024. Methods A multi-center prospective follow-up study conducted at the institutional level involved 356 preterm neonates, selected through consecutive sampling. A Weibull proportional hazards model was fitted to identify predictors of preterm neonatal mortality. Result The preterm neonatal mortality rate was 72 per 1,000 person-days of observation. The median time to death was 10 days (IQR = 7–20 days). Predictors of preterm neonatal mortality included young maternal age (15–19 years) [AHR 2.73 (95% CI: 1.3–5.9)], extremely low birth weight [AHR 2.4 (95% CI: 1.24–4.6)], respiratory distress syndrome [AHR 2.3 (95% CI: 1.34–3.8)], early preterm birth [AHR 1.8 (95% CI: 1.1–3)], lack of kangaroo mother care [AHR 2.2 (95% CI: 1.54–3.21)], multiple pregnancy [AHR 2.1 (95% CI: 1.1–4.3)], necrotizing enterocolitis [AHR 1.53 (95% CI: 1.1–2.22)], suboptimal continuous positive airway pressure therapy [AHR 1.43 (95% CI: 1.02–2.02)], and congenital anomalies [AHR 2.3 (95% CI: 1.32–3.9)]. Conclusion The current study revealed that preterm neonatal mortality significantly exceeds the national average and is unacceptably high, necessitating immediate intervention. This underscores the urgency to improve optimal childbearing age, optimize continuous positive airway pressure therapy, improve kangaroo mother care practices, and enhance the management of necrotizing enterocolitis and respiratory distress syndrome.