| Summary: | Abstract Background Neonatal mortality is a major global public health problem. Ethiopia is among seven countries that comprise 50 % of global neonatal mortality. Evidence on neonatal mortality in referred neonates is essential for intervention however, there is no enough information in the study area. Neonates who required referral frequently became unstable and were at a high risk of death. Therefore, this study aimed to assess the incidence and predictors of mortality among referred neonates. Method A prospective follow-up study was conducted among 436 referred neonates at comprehensive specialized hospitals in the Amhara regional state, North Ethiopia 2020. All neonates admitted to the selected hospitals that fulfilled the inclusion criteria were included. Face-to-face interviews, observations, and document reviews were used to collect data using a semi-structured questionnaire and checklists. Epi-data™ version 4.2 software for data entry and STATA™ 14 version for data cleaning and analysis were used. Variables with a p-value < 0.25 in the bi-variable logistic regression model were selected for multivariable analysis. Multivariable analyses with a 95% confidence level were performed. Variables with P < 0.05 were considered statistically significant. Result Over all incidence of death in this study was 30.6% with 95% confidence interval of (26.34–35.16) per 2 months observation. About 23 (17.83%) deaths were due to sepsis, 32 (24.80%) premature, 40 (31%) perinatal asphyxia, 3(2.33%) congenital malformation and 31(24.03%) deaths were due to other causes. Home delivery [AOR = 2.5, 95% CI (1.63–4.1)], admission weight < 1500 g [AOR =3.2, 95% CI (1.68–6.09)], travel distance ≥120 min [AOR = 3.8, 95% CI (1.65–9.14)], hypothermia [AOR = 2.7, 95% CI (1.44–5.13)], hypoglycemia [AOR = 1.8, 95% CI (1.11–3.00)], oxygen saturation < 90% [AOR = 1.9, 95% (1.34–3.53)] at admission time and neonate age ≤ 1 day at admission [AOR = 3.4, 95% CI (1.23–9.84) were predictors of neonatal death. Conclusion The incidence of death was high in this study. The acute complications arising during the transfer of referral neonates lead to an increased risk of deterioration of the newborn’s health and outcome. Preventing and managing complications during the transportation process is recommended to increase the survival of neonates.
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