Time to death and its predictors of mortality among neonates admitted to neonatal intensive care unit in public general hospitals of central zone of Tigray, Ethiopia 2024: a retrospective cohort study.

BACKGROUND: Neonatal mortality, accounting for nearly half of global under-five deaths, declines slower than post-neonatal mortality. Preterm birth, perinatal asphyxia, and infections are leading causes in Ethiopia, where skilled birth attendance, Kangaroo Mother Care, and Antenatal Care are prioritized. The Ethiopia Demographic Health Survey noted a rise in neonatal mortality from 29 to 30 deaths per 1000 live births (2016-2019). This trend highlights critical gaps in prevention and healthcare delivery. Targeted research is essential to reduce preventable deaths and enhance child survival. OBJECTIVES: To determine Time-to-Death and Predictors of Neonatal Mortality Among Neonatal Intensive Care Unit, Admissions in Public General Hospitals of Tigray's Central Zone, Ethiopia: A 2024 Cohort Study. METHODS: A hospital-based retrospective cohort study involved 357 neonates selected via systematic random sampling. Data was coded and entered using Epi-data 4.6 and analyzed with STATA 14. Kaplan-Meier analysis estimated the median survival time. Log rank tests compared survival differences across explanatory variable categories. The Cox proportional hazard regression model assessed relationships between independent and outcome variables. Model fitness was evaluated graphically using the Cox Snell residual graph. RESULT: Among 357 Neonates, 60(16.8%) died with an overall incidence rate of 17.7 (95%CI: 13.7, 22.8) deaths/1000 neonates-days total follow-up 3388 days. And the median survival time was 27 days. The predictors of neonatal mortality were rural residence (AHR = 3.44, 95% CI: 1.55, 7.66), lack of ANC (AHR = 2.80, 95% CI: 1.22, 6.51), HIV positive Mothers (AHR = 2.93; 95% CI: 1.27, 6.72) and delayed breast feeding (AHR = 2.12, 95% CI: 1.07, 4.20). CONCLUSION: Neonatal mortality was 17.7 per 1000 neonate-days, with a median survival of 27 days. Rural residence, no ANC visits, maternal HIV positivity, and delayed breastfeeding were key predictors of neonatal death. Programs should focus on improving ANC access and community-based survival strategies, especially for rural mothers. Enhanced efforts are critical to reduce neonatal mortality.