Published in PLOS One on 2026-04-17, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Boru Abera Ebsa, Maleda Tefera, Dawit Tamiru, Abraham Negash, Naol Oda, Merga Dheresa
Source: PLOS One • DOI 10.1371/journal.pone.0347244
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
The neonatal period is the most vulnerable time for an infant’s survival, particularly for preterm neonates. Preterm birth is among the leading causes of neonatal mortality. Many neonatal complications can be prevented, but preterm birth remains a leading cause of admission, death, and long-term complications, highlighting the need for further research on outcome and survival disparities across populations and settings. Therefore, this study aimed to assess survival status and predictors of mortality among preterm neonates admitted to neonatal intensive care units at public hospitals in the Harari region and Dire Dawa administration, Eastern Ethiopia, from November 1, 2021 to October 30, 2024.
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.
Out of 612 preterm neonates, 205 (33.5%; 95% CI: 29.76–37.39) died, corresponding to an incidence rate of 52.76 deaths per 1,000 preterm neonate-days (95% CI: 46.01–60.50), with a 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.
The incidence of preterm neonatal mortality was high in this study. Adequate Antenatal care (ANC) and kangaroo mother care (KMC) 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.
Introduction
Preterm birth is defined as a live birth born before 37 completed weeks of pregnancy or less than 259 days from the first date of the woman’s last normal menstrual period [1,2]. Preterm birth is classified as very preterm (28 to < 32 weeks), moderate preterm (32 to <34 weeks), and late preterm (34 to <37 completed weeks) based on gestational age [1,3]. The majority of preterm births occur spontaneously, while others are caused by medical conditions like infections or other pregnancy complications that require early labor induction or cesarean delivery [1].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Boru Abera Ebsa, Maleda Tefera, Dawit Tamiru, Abraham Negash, Naol Oda, Merga Dheresa. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Neonatal survival and mortality predictors among low-birth-weight neonates: A Retrospective cohort study from Suhul Hospital, northern Ethiopia
- Evidence brief: Prevalence and associated factors of meconium aspiration syndrome among neonates admitted to Neonatal Intensive Care Units in Public Hospitals of Harari Region, Eastern Ethiopia
- Evidence brief: Incidence of mortality and its predictors among low birth weight neonates in Ethiopia: Systematic review and meta-analysis
