Maternal and Neonatal Predictors of Severe Adverse Outcomes among Low-Birth-Weight Neonates in Kericho County, Kenya

Background. Low-birth-weight (LBW) neonates carry a disproportionate share of newborn morbidity and mortality in sub-Saharan Africa. Distinguishing which maternal and neonatal characteristics mark the highest risk supports bedside risk stratification in resource-limited newborn units. This study examined maternal and neonatal predictors of severe adverse outcomes among LBW neonates admitted to a county referral hospital in Kenya. Methods. A facility-based cross-sectional analysis was conducted on 169 LBW neonate-mother pairs admitted to the newborn unit at Kericho County Referral Hospital. The outcome was a severe adverse outcome, defined as a composite of respiratory distress, sepsis, hypothermia, hypoglycaemia, prolonged admission (>= 7 days), or neonatal death. Maternal and neonatal factors were screened using chi-square, Fisher's exact, and independent-samples t tests, with crude odds ratios (ORs) and 95% confidence intervals (CIs). A restricted multivariable logistic regression, limited to maternal and neonatal predictors, produced adjusted odds ratios (AORs). Results. Severe adverse outcomes occurred in 136 of 169 neonates (80.5%). At the bivariate level, pregnancy-induced hypertension (PIH; OR = 6.69, 95% CI 1.53-29.27, p = 0.004) and preterm birth (OR = 3.79, 95% CI 1.50-9.56, p = 0.003) were associated with higher odds of a severe outcome, and severe outcomes clustered at lower birth weight and gestational age and higher neonatal risk-factor counts (all p < 0.001). In the restricted adjusted model, PIH (AOR = 7.66, 95% CI 1.56-37.55, p = 0.012) and birth weight (AOR = 0.997 per gram, p = 0.002) retained independent significance. Conclusion. Neonatal biological vulnerability-particularly lower birth weight-together with maternal pregnancy-induced hypertension were the predictors most strongly and independently associated with severe adverse outcomes. Risk stratification of LBW neonates should prioritise the smallest infants and those born to mothers with hypertensive disease. Keywords: low birth weight; neonatal outcomes; pregnancy-induced hypertension; preterm birth; risk stratification; Kenya