Among the 160 newborns included, the majority were born within the same maternity unit (inborn, 83.8%), while 16.3% were referred from other health facilities (outborn).The main reasons for admission were respiratory distress (37.5%), prematurity (32.5%), neonatal sepsis (13.7%), and perinatal asphyxia (7.5%).Cases of status epilepticus (5%) and congenital malformations (3.8%) were also reported. Male infants slightly predominated, accounting for 59.4% compared to 40.6% females. Regarding gestational age, preterm newborns represented two-thirds of cases (65%), while 33.1% were term infants and 1.9% were extremely preterm (<28 weeks). Birth weight ranged from 850 g to 4600 g. Newborns with normal birth weight (2500 - 3999 g) represented 31.3%, whereas very low birth weight (<1500 g) accounted for 37.5% of the population. Macrosomia infants were rare (2.5%). From a trophic standpoint, most newborns were eutrophic (78.1%), followed by hypotrophic (18.1%) and macrosomia (3.8%). The Apgar score at the 5th minute was below 6 in 56.9% of newborns, indicating a significant proportion of perinatal asphyxia. Respiratory distress was moderate in nearly half of the cases (49.4%) and severe in 38.8%. Neurologically, 60% of newborns had a normal condition. Hypoxic-ischemic encephalopathy of Sarnat stage II and III was observed in 19.4% and 10% of cases respectively, while 6.9% showed neurological disorders related to prematurity. Table 2 summarizes the neonatal characteristics.

The most frequently encountered pathologies among hospitalized newborns were presumed neonatal bacterial infections (PNBI), observed in 93.8% of the infants, followed by hyaline membrane disease (HMD) (51.9%) and perinatal asphyxia (32.5%). Metabolic disorders and sepsis each accounted for 18.8%, while anemia was noted in 18.1% of cases. Neonatal jaundice (NHND) was recorded in 12.5% of the infants, congenital malformations in 5.6%, and congenital or neonatal encephalopathies (CNE) in 1.9%. The main complications observed were nosocomial infection (30.6%), neonatal hemorrhagic disease (NHND) (16.3%), disseminated intravascular coagulation (DIC) (15%), and status epilepticus (13.1%). Other severe complications included multiorgan failure (6.9%), neonatal encephalopathy (5%), and septic shock (1.9%). Regarding the outcomes of newborns, more than half (54.4%) were transferred to other specialized departments, mainly pediatric surgery, while 39.4% of infants died during hospitalization. Discharges with improvement were rare (2.5%), as were surgical transfers (1.25%) and discharges against medical advice (2.5%). Table 3 summarizes the pathologies encountered, complications, and outcomes of the newborns.

No statistically significant association was found between the mode of delivery and neonatal death, although the risk of death among infants born by vaginal delivery was 1.6 times higher than that observed after cesarean section. Similarly, there was no significant association between the sex of the newborn and mortality. However, a statistically significant association was observed for an Apgar score below 7 at the 5th minute. The risk of death was 1.9 times higher among newborns with a score < 7 compared to those with a score ≥ 7. Regarding gestational age, no significant association was found, although the risk of death was 1.6 times higher among post-term infants. A significant association was identified between neurological status at admission and mortality, with the risk of death being approximately 2.5 times higher among newborns with Sarnat stage III compared to others. A significant relationship was also found between respiratory distress and death. Newborns with a Silverman score between 3 and 4 had a 1.4 times higher risk of death, while those with a score ≥ 5 had a 1.6 times higher risk. Finally, a significant association was observed between birth weight and mortality. Newborns weighing less than 1000 g had a 2.5 times higher risk of death, and those weighing between 1500 and 2000 g had a 2.1 times higher risk. Table 4 summarizes the Factors Associated with Neonatal Death

In this study, most mothers were between 20 and 40 years old, with a predominance of women working in the informal sector. This profile reflects the demographic structure of Côte d’Ivoire, where women of childbearing age are generally young and economically active within the informal economy [8] . These findings are consistent with other African studies showing that socioeconomic vulnerability, low education level, and limited access to antenatal care are major determinants of neonatal risk [9] - [11] . In our population, 85% of mothers had attended fewer than six antenatal consultations, which is below the World Health Organization’s recommendation of at least eight visits to ensure optimal maternal and fetal surveillance [12] [13] .

Most newborns admitted to the neonatal intensive care unit (NICU) were inborn (83.8%), reflecting both an effective perinatal referral system and a high burden of local neonatal morbidity. The main causes of admission were respiratory distress (37.5%), prematurity (32.5%), and neonatal sepsis (13.7%). These findings are similar to those reported by Haile and Tewele in Ethiopia [14] and Seid et al. in Jimma [15] , who documented respiratory distress and sepsis rates of 17.7% each. These conditions remain the leading causes of neonatal hospitalization in African NICUs, underscoring the heavy contribution of prematurity and perinatal infections to neonatal morbidity [3] [16] . Premature infants represented nearly two-thirds of admissions, confirming their high vulnerability to respiratory and metabolic complications [17] [18] . Very low birth weight infants (<1500 g) accounted for 37.5% of cases, consistent with findings from Sourerya et al. in Cameroon [18] .

The most frequent pathologies observed were presumed neonatal bacterial infection (93.8%), hyaline membrane disease (51.9%), and perinatal asphyxia (32.5%). These results are in line with those of Al-Nafeesah et al. in Saudi Arabia [19] and Thomas et al. in Ethiopia [20] . The high rate of neonatal infections in our cohort may be attributed to inadequate hygiene practices, prematurity, and the lack of standardized infection prevention protocols, as also reported by Garba et al. in Niger [21] . Severe respiratory distress, affecting 38.8% of newborns, was comparable to data from Faye et al. in Dakar (47.7%) [22] and can be explained by the high proportion of premature infants and surfactant deficiency [23] [24] . Neurological disorders were present in 40% of infants, higher than the 18% reported by Sheth [25] , likely due to delayed transfer and perinatal asphyxia.

The neonatal mortality rate observed in this study (39.4%) remains high but comparable to findings from other African studies [26] - [28] . The main factors significantly associated with mortality were respiratory distress, low birth weight, neurological impairment, and an Apgar score < 7 at the fifth minute, all previously identified as key predictors of neonatal death in African settings [27] [29] [30] . This elevated mortality rate reflects both the severity of admitted cases and the limitations in human and technical resources in neonatal intensive care units.

This study has some limitations. First, its cross-sectional and single-center design limits the generalizability of the findings to other neonatal care settings. Second, some clinical and laboratory data were retrospectively extracted from medical records, which may have led to missing or incomplete information. Third, microbiological confirmation of infection was not systematically performed for all cases, possibly resulting in an overestimation of presumed bacterial infections. Finally, only univariate analyses were conducted, as the limited sample size and collinearity between variables such as gestational age, birth weight, and respiratory distress prevented reliable multivariate modeling. Despite these limitations, this study provides valuable insight into neonatal morbidity and mortality patterns in a tertiary hospital in Côte d’Ivoire and highlights priorities for improving newborn care.