Abstract:
Background: The neonatal period is the most vulnerable time for an infant’s survival,
particularly for preterm neonates. Complications related to preterm birth are among the leading
causes of death in neonates. Many of these complications are preventable with available
resources and intensive intervention. However, preterm birth remains a major cause of
admission, mortality, and long-term consequences, underscoring the need for further research to
assess outcome variability and survival disparities across different populations and settings.
Objective: To determine time to death and its predictors among preterm neonates admitted to
neonatal intensive care units at public hospitals in the Harari region and Dire Dawa city
administration, Eastern Ethiopia, from November 1, 2021 to October 30, 2024.
Methods: The hospital-based retrospective cohort study was conducted among preterm
neonates admitted to the neonatal intensive care unit at public hospitals of the Harari region and
Dire Dawa administration, Eastern Ethiopia. A simple random sampling technique was used,
and data were extracted from neonates’ medical records and registration formats using a
structured checklist prepared in English. Descriptive statistics, life table, Kaplan-Meier curves,
and Log-rank test were used to estimate and compare survival time. Predictors of mortality were
identified using the Cox proportional hazard model.
Results: Out of 612 preterm neonates, 205 (33.50%) died with an incidence rate of 52.76 (95%
CI: 46.01 to 60.50) deaths per 1000 preterm neonate-days with median survival time of 18 days.
As multivariable cox-regression result, ≥ 4 antenatal care contact (AHR: 0.56 (95% CI: 0.36 –
0.89)), receiving KMC (AHR: 0.16 (95% CI: 0.09 - 0.27), 5th minute APGAR score <7 (AHR:
1.80 (95% CI: 1.22 - 2.66)), PNA (AHR: 1.55 (95 CI: 1.08 - 2.22)), resuscitation with bag and
mask at birth (AHR: 1.59 (95% CI: 1.10 - 2.29)), RDS (AHR: 1.75 (95% CI: 1.22-2.51)), born
in non-cephalic presentation (AHR:1.68 (95% CI: 1.12 - 2.53)), and neonatal sepsis (AHR: 1.58
(95% CI: 1.09 - 2.28)) were identified as significant predictors of preterm neonates mortality.
Conclusion: The cumulative incidence of preterm neonatal mortality was high in this study.
Adequate ANC and kangaroo mother care significantly improved preterm survival, while low
APGAR score, resuscitation with bag and mask, neonatal sepsis, PNA, and RDS were major
predictors of preterm neonatal death. Emphasis should be placed on strengthening antenatal and
perinatal care, along with early detection and management of identified neonatal complications.
