Clinical characteristics and in-hospital mortality outcomes of admitted neonates at the MSF-supported Al-Salam MOH Hospital, Amran Governorate, Yemen: A retrospective descriptive analysis

BACKGROUND

Globally, about 2.3 million neonates die annually, most of them in low-resource and conflict-affected countries. In Yemen, ongoing humanitarian crises put children at continued risk, with neonates being the most vulnerable group. This study aimed to assess the in-hospital neonatal mortality rate and to describe the demographic and clinical characteristics.

METHODS

A retrospective cohort design reviewing all neonatal admissions to the Neonatal Inpatient Department (NIPD) at Al-Salam Hospital in Amran Governorate, January to December 2023. Data were extracted from hospital records entered REDCap and analyzed using R 4.3.1. Both descriptive and inferential statistics were applied: chi-square, t-tests for bivariate analysis, and logistic regression was used to identify predictors of neonatal mortality. Statistical significance at p < 0.05.

RESULTS

A total of 882 neonates were included; 51% were inborn and 49% outborn. Median age was 1 day (IQR 0–6) and a median admission weight of 2,500 g (IQR 1,860–2,975), male neonates accounted for 57%. The commonest diagnoses were clinically suspected sepsis (72%), low birth weight (48%), prematurity (32%), perinatal asphyxia (20%), and meningitis (5%). Among neonates receiving oxygen (72%), HHFNC use was more common among mortalities (15% vs. 8%), no significant difference was observed for nasal cannula use (95% vs. 94%). Antibiotics were administered to 96% of neonates; among deaths, cefotaxime was most frequently used and for a shorter duration (37% vs. 17%; 1 vs. 5 days). Antibiotic regimen modification was more frequent among neonates with in-hospital mortalities (40% vs. 23%), particularly when escalating to vancomycin (27% vs. 7.2%) and meropenem (31% vs. 10%). Maternal risk factors, including PROM in 35% (45% lasting ≥18h), history of abortions, lower gestational age, and low hemoglobin, were associated with increased risk of in-hospital mortality. The overall mortality rate was 17.4%. In multivariable analysis, very low birth weight (VLBW; <1500 g), perinatal asphyxia, and meningitis were independent mortality predictors, whereas admission after 7 days of life and higher maternal hemoglobin were associated with improved survival.

CONCLUSIONS

Neonatal mortality at Al-Salam Hospital remained high, and was associated with VLBW, prematurity, and perinatal asphyxia, highlighting the need to strengthen maternal care, neonatal resuscitation, Kangaroo Mother Care, and antibiotic stewardship in fragile humanitarian settings.