Neonatal deaths now account for 47% of all deaths in children younger than 5 years globally. More than a third of newborn deaths are due to preterm birth complications, which is the leading cause of death. Understanding the causes and factors contributing to neonatal deaths is needed to identify interventions that will reduce mortality. This study aimed to establish the major causes of preterm mortality in preterm infants in the first 28 days of life in Ethiopia. They did a prospective, cross-sectional, observational study at five hospitals in Ethiopia. Participants of the study were preterm infants born in the study hospitals at younger than 37 gestational weeks. Infants whose gestational age could not be reliably estimated and those who were born as a result of induced abortion were excluded from the study. The data were collected on maternal and obstetric history, clinical maternal and neonatal conditions, and laboratory investigations. For neonates who died of those enrolled, consent was requested from parents for post-mortem examinations (both complete diagnostic autopsy and minimally invasive tissue sampling). An independent panel of experts established the primary and contributory causes of preterm mortality with available data. Between July 1, 2016, to May 31, 2018, 4919 preterm infants were enrolled in the study, and 3852 were admitted to neonatal intensive care units. By 28 days of post-natal age, 1109 (29%) of those admitted to the neonatal intensive care unit died. A complete diagnostic autopsy was done in 441 (40%) and minimally invasive tissue sampling in 126 (11%) of the neonatal intensive care unit deaths. The main primary causes of death in the 1109 infants were established as respiratory distress syndrome (502 [45%]); sepsis, pneumonia, and meningitis (combined as neonatal infections; 331 [30%]), and asphyxia (151 [14%]). Hypothermia was the most common contributory cause of preterm mortality (770 [69%]). The highest mortality occurred in infants who were younger than 28 weeks of gestation (89 [86%] of 104), followed by infants aged 28–31 weeks (512 [54%] of 952), 32–34 weeks (349 [18%] of 1975), and 35–36 weeks (159 [8%] of 1888. Three conditions accounted for 89% of all deaths among preterm infants in Ethiopia. Scale-up interventions are needed to prevent or treat these conditions. 

• Cause of Death
• Child Mortality
• Child
• Preschool
• Cross-Sectional Studies
• Female
• Gestational Age
• Humans
• Infant
• Infant Death/etiology
• Infant
• Newborn
• Infant
• Premature
• Male
• Prospective Studies

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When babies are born early or are preterm, they may develop conditions that place them at a higher risk for short-term health problems, long-term neurological complications, and even death. In the United States and other high-income countries, most infants born preterm now survive, but in the poorest regions of the world, babies who are born preterm are at very high risk of death; in the first month of life up to half may die. To date, few studies have examined the specific conditions that lead to deaths among preterm babies in low-income countries. In this paper, they describe an approach that was used for a study about the reasons why preterm babies cared for in 5 hospitals in Ethiopia die. After consent, they collected extensive information about all preterm babies cared for in the hospital including information on the care given during pregnancy, labor, and delivery as well as for the baby at the hospital. For those babies who die, additional information, including testing for infections and with permission, the examination of the body after death was also done. A group of experts then evaluated all the information collected to determine the final cause of the baby’s death. 

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