Published in PLOS One on 2026-08-03, 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: Abrahaley Brhane Gebrekidan, Negasi Asres Mesfin, Kiros Gereziher Arafayne, Getachew Mebrahtu Welay
Source: PLOS One • DOI 10.1371/journal.pone.0354163
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Neonates, defined as infants within the first 28 days of life, are especially vulnerable in conflict-affected settings. Globally, about 2.3 million neonatal deaths occur annually, with nearly 98% occurring in low- and middle-income countries. Despite several studies in this area, context-specific evidence remains limited, and knowledge and data gaps continue to hinder efforts to address health inequalities in resource-limited settings. This study, therefore, aims to evaluate neonatal mortality and identify its key predictors.
This study aimed to assess neonatal mortality and identify its associated risk factors.
A hospital-based retrospective cohort study was conducted among 329 neonates admitted between 2021 and 2023. Data were extracted from medical charts, registers, and maternal and neonatal history sheets. Kaplan-Meier survival curves and Cox regression models were used for analysis. Log-rank test and proportional hazards assumption were evaluated. Predictors of neonatal mortality were identified using Cox proportional hazards regression model, with statistical significance set at p < 0.05.
The overall neonatal mortality rate was 216 per 1,000 live births (95% CI: 190.5–241.5), with a median survival time of 52 days. Multivariable Cox regression identified respiratory distress syndrome (RDS) and delayed initiation of breastfeeding as significant predictors of neonatal mortality. RDS was associated with an increased risk of death [AHR = 2.00, 95% CI: 1.16–3.46]. Compared with breastfeeding initiated within one hour of birth, delayed initiation of breastfeeding was associated with a higher risk of mortality [AHR = 6.23, 95% CI: 3.03–12.82], whereas formula feeding showed a similar trend that did not reach statistical significance [AHR = 2.602, 95% CI: 0.835–8.10].
Neonatal mortality in this study was substantially high. Delayed initiation of breastfeeding and respiratory distress syndrome were identified as significant predictors of neonatal death. Public health interventions should focus on addressing modifiable risk factors for neonatal mortality. Strengthening postnatal maternal health education, promoting early initiation of breastfeeding, and increasing community awareness are essential. In addition, prioritizing respiratory distress syndrome management through effective infection prevention and control measures, quality neonatal care, and timely access to oxygen and surfactant therapy could enhance neonatal survival.
Introduction
Neonates, defined as infants from birth through 28 days of age [1], are highly vulnerable to risks stemming from conflict-related maternal and neonatal exposures. Newborns exhibit distinct immunological and physiological characteristics compared to adults, rendering them particularly vulnerable to diseases and death. These inherent vulnerabilities contribute to a global neonatal health crisis, with an estimated 2.3 million deaths occurring annually and approximately 6,300 deaths each day [1]. The burden is disproportionately concentrated in low- and middle-income countries (LMICs), accounting for nearly 98% of neonatal deaths, where limited access to quality healthcare for preventable conditions is further compounded by conflict and displacement [2–4]. In LMICs, including Ethiopia, the neonatal mortality rate is estimated at 27 deaths per 1,000 live births, with nearly 75% of all neonatal deaths occurring within the first week of life [5,6].
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 hospital systems 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 Abrahaley Brhane Gebrekidan, Negasi Asres Mesfin, Kiros Gereziher Arafayne, Getachew Mebrahtu Welay. 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.
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