Prematurity is defined as birth occurring before 37 weeks of gestation. According to the World Health Organization, approximately 15 million babies are born prematurely each year worldwide, representing nearly 11% of all live births [1].

Prematurity is currently the leading cause of neonatal mortality and one of the major causes of death among children under five years of age [2]-[4]. Complications related to prematurity account for nearly one million deaths annually.

The incidence of prematurity varies considerably between countries. In the United States, the prevalence is estimated at about 10.5%, whereas in France it is approximately 6.6% [5].

In sub-Saharan Africa, several studies have reported high rates of prematurity, including 21.4% in N’Djamena (Chad) and 9.9% in Oran (Algeria) [6][7].

In low- and middle-income countries, limited access to neonatal intensive care, insufficient medical equipment, and a shortage of trained health professionals contribute significantly to neonatal mortality [8][9].

In the Democratic Republic of Congo, prematurity represents a substantial proportion of neonatal deaths. However, data on the determinants of mortality among preterm newborns remain limited [10][11].

The aim of this study was to identify factors associated with mortality among preterm newborns hospitalized in several health facilities in Kisangani.

This study highlights a high in-hospital mortality rate among preterm neonates in Kisangani (33.3%), underscoring the persistent burden of prematurity in low-resource settings. Similar mortality rates ranging from 25% to 40% have been reported in sub-Saharan Africa [6][7].

The absence of antenatal care was strongly associated with mortality, which is consistent with findings from low- and middle-income countries where inadequate prenatal follow-up contributes significantly to adverse neonatal outcomes [8][12].

Apnea and respiratory immaturity are well-recognized complications of prematurity and major contributors to neonatal mortality [13][14][15].

Neonatal complications such as respiratory distress, apnea, anemia, and hypothermia were major contributors to mortality. These findings are consistent with previous studies highlighting the critical role of respiratory immaturity and thermal instability in preterm deaths [11][16].

In contrast, significantly lower mortality rates—generally below 10%—are reported in high-income countries, largely due to advanced neonatal care, including mechanical ventilation, surfactant therapy, and well-established perinatal systems [10][17].

Our findings are also consistent with studies conducted in the Democratic Republic of Congo and other African settings, which emphasize the role of limited healthcare resources and inadequate neonatal care infrastructure [5][6][17].

Global estimates further confirm the substantial burden of prematurity and neonatal mortality worldwide [4][12][18].

Studies from Ethiopia and Tanzania report comparable mortality rates, reflecting similar constraints in neonatal care capacity [15][20].

Overall, preterm mortality in Kisangani appears to be driven by both biological vulnerability and systemic healthcare limitations, consistent with findings reported in other African contexts [7][11][18].

Multicenter design.Prospective data collection.Robust statistical analysis.

This hospital-based study may be subject to selection and referral bias. Residual confounding cannot be excluded. Follow-up was limited to hospitalization.

Preterm mortality remains high in Kisangani and is associated with both maternal factors and neonatal complications. Strengthening antenatal care and improving neonatal care quality are critical priorities.

None.

Jean Hubert Tshishimbi Kalala contributed to the study design and clinical assessment of preterm newborns. Data collection was performed by Jean Hubert Tshishimbi Kalala, Scapin Kabongo Mudipanu, and Véronique Muyobela Kampunzu. Data analysis was conducted by Alphonse Lufuluabu Mpemba. Manuscript revision was performed by Gaspard Mande Bukaka, Dadi Falay Sadiki, Emmanuel Tebandite Kasai, and Jean Pierre Alworong’a Opara. All authors read and approved the final version.