Mortality and Its Predictors Among Preterm Neonates in a Conflict-Affected Low-Resource Setting: A Retrospective Cohort Study From Syria

Preterm birth is a major contributor to neonatal morbidity and mortality, particularly in low-resource and conflict-affected settings. This retrospective cohort study assessed mortality and associated factors among preterm neonates admitted to a tertiary neonatal unit in Damascus, Syria, between January 2022 and December 2023. Data were extracted from medical records using a standardized data collection form, and CRIB II scores were calculated retrospectively. Of 480 records reviewed, 330 neonates were included after exclusion of 150 records. Among them, 208 died (63.0%), with a mean time to death of 10.2 days. Higher CRIB II scores (HR 1.093, p=0.017), respiratory distress (HR 2.4, 95% CI 1.8–3.1; p<0.001), and hyaline membrane disease (HR 1.79, p<0.001) were associated with increased mortality. Maternal parity of five or more was associated with lower mortality (HR 0.559, p=0.026). Mortality was high, highlighting challenges in conflict-affected, resource-constrained neonatal care. CRIB II may support early risk stratification.