Abstract
BACKGROUND: Neonatal mortality remains high globally, with an estimated 2.4 million neonatal deaths in 2020. In Ethiopia, neonatal mortality is particularly concerning. Despite some research, data on neonatal mortality incidence and influencing factors are limited. This study aimed to assess the incidence of neonatal mortality and identify factors affecting neonatal mortality in intensive care units. METHODS: A prospective follow up cohort study was conducted in public hospitals in northern Ethiopia from October 2021 to May 2022, involving 334 neonates admitted to the intensive care unit. Systematic random sampling was employed to select participants, and data were collected through structured interviews and chart reviews. Data were analyzed using STATA 14, with a Cox model to calculate hazard ratios (AHR) and 95% confidence intervals (CI), considering statistical significance at P<0.05. RESULTS: The neonatal mortality incidence rate was 23.21 per 1000 person-days (95% CI: 17.15, 31.41). Significant predictors of neonatal mortality included: no antenatal care (ANC) utilization (AHR: 3.69; 95% CI: 1.62, 8.42), a 5-minute APGAR score <7 (AHR: 0.38; 95% CI: 0.19, 0.77), prematurity (AHR: 0.34; 95% CI: 0.13, 0.90), and perinatal asphyxia (PNA) (AHR: 0.17; 95% CI: 0.04, 0.66). CONCLUSION: The neonatal mortality rate was high. ANC utilization, 5-minute APGAR score <7, prematurity, and PNA were significant predictors. Healthcare professionals should prioritize these factors to improve neonatal survival in intensive care units.