Incidence and predictors of mortality among preterm neonates admitted to the neonatal intensive care unit of Wallaga University Comprehensive Specialized Hospital, Nekemte Town, East Wallaga, Oromia, Ethiopia: a retrospective cohort study

BACKGROUND Preterm birth affects 1 in 10 babies globally, with disproportionately high mortality in low-income settings. Sub-Saharan Africa bears a significant burden due to limited healthcare access. Despite the availability of modifiable risk factors and cost-effective interventions, data on incidence of mortality of preterm neonates in the study area is lacking. OBJECTIVE To assess incidence and predictors of mortality among preterm neonates admitted to the neonatal intensive care unit of Wallaga University Comprehensive Specialized Hospital, Nekemte Town, Oromia, Ethiopia, from July 1, 2022, to June 30, 2024. METHODS An institution-based retrospective cohort study was conducted among 264 preterm neonates admitted to the NICU within the study period and study subjects were selected using systematic random sampling technique. Data were collected using a structured checklist, entered via EpiData version 4.6, and subsequently analyzed using STATA version 14.0. Kaplan-Meier and log-rank tests were used to compare survival probability and assess statistically significance difference between groups. The Cox proportional hazards model assumption was checked. A bivariable Cox regression analysis was fitted and those variable with p < 0.2 were included in the multivariable analysis. Finally, statistical significance was declared at a p-value < 0.05. RESULTS Of 259 preterm neonates, 42 died during follow up time, with incidence proportion of 16%. The median survival time was 28 days (IQR: 22–30), with 2,737 neonate-days of follow-up. The overall incidence rate of mortality was 15.3 per 1,000 neonate-days (95% CI: 11.3–20.7). Significant predictors of mortality included were lack of ANC follow-up (AHR: 2.27, 95% CI: 1.13–4.57), antenatal steroid use (AHR: 0.44, 95% CI: 0.21–0.92), home delivery (AHR: 7.74, 95% CI: 1.99–30.03), and presence of hypothermia (AHR: 4.11; 95% CI: 1.55–10.85). CONCLUSION AND RECOMMENDATION: The study identified key clinical and maternal predictors associated with preterm neonatal mortality. Targeted interventions focusing on antenatal care, delivery practices, steroid administration, and thermal regulation are essential.