RESUMO
Background: Nakuru county has 41.9 neonatal deaths per 1000 live births, more than double the national average of 19. This study examined Nakuru level 5 hospital neonatal mortality risk factors. Methods: A retrospective mismatched case-control study was used. The 429 neonates (143 cases and 286 controls) were estimated assuming a 1:2 case-to-control ratio and 18% prevalence of exposure among controls. Binary logistic regression measured dependent-independent variable correlation. Results: The study found that high parity, high number of stillbirths, positive HIV, HBsAg, syphilis, pregnancy-induced hypertension, antepartum hemorrhage, PROM 18hours, and maternal peri-partum increased the risk of neonatal. Similarly, mothers who had fewer ANC visits throughout their pregnancy had a higher risk of neonatal mortality compared to mothers who attended more than three ANC clinics, with mortality risk reducing by 69% and 59% for 1-2 visits and more than 3 visits, respectively, compared to non-attendance. Vaginal aided birth had an or of 2.188 and vaginal unassisted OR=4.533 compared to caesarian delivery. Antibiotics and prenatal dexamethasone decreased maternal mortality. Antibiotics lowered NMR or 0.381. Newborns admitted from referral facilities or labor wards had or 1.11 and or 6.220 death rates. Low birth weight, admission weight, gain weeks, and congenital defects increased mortality. In this study, birthweight decreased newborn mortality. Conclusions: The study concluded that maternal characteristics, neonatal complications are key to improving neonatal outcomes. The study recommends regular training of staff working in the maternity and newborn unit on emergency care and neonatal resuscitation.