Patterns of preterm admission, morbidity, and mortality in a tribal-district neonatal intensive care unit: A retrospective cohort study

BACKGROUND Preterm birth remains the leading cause of neonatal morbidity and mortality worldwide. Data from tribal-district neonatal intensive care units (NICUs) in India are scarce, despite these populations bearing a disproportionate burden of adverse perinatal outcomes. AIM To evaluate morbidity patterns and identify predictors of mortality among preterm neonates in a tribal-district NICU. METHODS The present retrospective cohort study included total 1438 preterm neonates admitted between January 2022 and December 2024 to the tribal-district NICU. Clinical data were extracted from medical records. Mortality was analyzed by gestational age. Multivariable logistic regression, with multiple imputation for missing data, was used to identify independent predictors of in-hospital mortality. RESULTS Mortality demonstrated a steep inverse gradient with gestational age, decreasing from 49% among extremely preterm neonates to 4.6% among late preterm infants. The most common morbidities were respiratory distress syndrome (42%-55%) and neonatal sepsis (32%-45%). Early continuous positive airway pressure (CPAP) initiation (< 1 hour) was associated with reduced need for mechanical ventilation (P < 0.001). In multivariable analysis, increasing gestational age [adjusted odd ratios (AOR): 0.82 per week; 95%CI: 0.75-0.89], higher birth weight (AOR: 0.93 per 100 g; 95%CI: 0.89-0.97), culture-positive sepsis (AOR: 3.41; 95%CI: 1.98-5.89), delayed CPAP initiation (AOR: 1.94; 95%CI: 1.15-3.28), and outborn status (AOR: 1.67; 95%CI: 1.01-2.74) were independently associated with mortality. Discharge against medical advice rates remained high (9%-11%). CONCLUSION Lower gestational age, lower birth weight, infection, and delayed respiratory stabilization are associated with mortality. Strengthening early neonatal care may improve survival in tribal settings.