{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T13:47:29Z","timestamp":1782827249394,"version":"3.54.5"},"reference-count":39,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,18]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to develop and internally validate a neonatal mortality risk prediction model for low birthweight (LBW) neonates in public hospitals of North-West Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>An institution-based prospective follow-up study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study was conducted in seven hospitals, comprising three general hospitals and four primary hospitals, between 14 February and 31 October 2025. The general hospitals, Injibara, Finote Selam and Pawi, provide level II neonatal intensive care services, whereas the primary hospitals, Dangila, Chagni, Jawi and Gimja Bet, provide level I newborn care services. These hospitals are situated in the Awi, West Gojjam and Metekel zones of the Amhara and Benishangul Gumuz regions in north-western Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>955 LBW neonates were enrolled in the study. Neonates born outside health facilities were excluded if their birth weight was unknown, particularly those delivered by traditional birth attendants, as were neonates whose first recorded weight was obtained more than 24 hours after birth. Participants were selected using consecutive sampling and data were collected electronically using the KoboCollect mobile application.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Data were analysed using R software V.4.4.3. Least Absolute Shrinkage and Selection Operator regression and multivariable logistic regression were used to identify predictors and develop a simplified risk score and nomogram. Model performance was evaluated in terms of discrimination and calibration, while internal validation was performed using bootstrapping. The clinical utility of the model was assessed using decision curve analysis (DCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The final model included nine predictors: sepsis, perinatal asphyxia, respiratory distress syndrome, absence of exclusive breastfeeding, absence of Kangaroo Mother Care, gestational ages of 28 weeks to &lt;32 weeks and 32 weeks to &lt;37 weeks, and birth weights of &lt;1000 g and 1000\u20131499 g. The original model demonstrated good discrimination, with an area under the curve of 84.2% (95% CI 81.5% to 86.9%). After internal validation, the simplified risk score and nomogram achieved areas under the curve of 83.85% and 83.5%, respectively. The model showed excellent calibration before and after validation. DCA indicated that the model provides meaningful clinical benefit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The nomogram and simplified risk score demonstrated excellent calibration and good discriminatory performance. Their application in clinical settings may improve early intervention and potentially reduce neonatal mortality in Ethiopia by enabling rapid, individualised mortality-risk prediction among LBW neonates. However, external validation in different settings is required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120111","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T13:18:56Z","timestamp":1782825536000},"page":"e120111","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Development and internal validation of a neonatal mortality risk prediction model for low birthweight neonates in public hospitals, North-West Ethiopia: a prospective follow-up study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1201-904X","authenticated-orcid":false,"given":"Daniel Mulat","family":"Eshetu","sequence":"first","affiliation":[{"name":"Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assefa Andargie","family":"Kassa","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4830-3599","authenticated-orcid":false,"given":"Wolde Melese","family":"Ayele","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2973-8142","authenticated-orcid":false,"given":"Mulatu","family":"Kassahun","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shashitu Tadele","family":"Zeleke","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betelhem Mekuriaw","family":"Anagaw","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikias Getahun","family":"Molla","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5524-7754","authenticated-orcid":false,"given":"Kalaab Esubalew","family":"Sharew","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birhanu Kassie","family":"Abeje","sequence":"additional","affiliation":[{"name":"Biomedical Sciences Education and Service Directorate, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2376-8983","authenticated-orcid":false,"given":"Chalachew Abiyu","family":"Ayalew","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"2026063005552090000_16.6.e120111.1","unstructured":"World Health Organization . Nutrition and nutrition-related health and development data: WHO. 2024. Available: https:\/\/www.who.int\/data\/nutrition\/nlis\/info\/low-birth-weight"},{"key":"2026063005552090000_16.6.e120111.2","doi-asserted-by":"crossref","first-page":"451","DOI":"10.2147\/PHMT.S323526","article-title":"Survival Status and Predictors of Mortality Among Low-Birth-Weight Neonates Admitted to the Neonatal Intensive Care Unit at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia, 2020","volume":"12","author":"Woelile","year":"2020","journal-title":"PHMT"},{"key":"2026063005552090000_16.6.e120111.3","doi-asserted-by":"crossref","unstructured":"Kebede BF , Genie YD , Aregawi DH , et al . Survival Status and Predictors of Mortality Among Low Birthweight Neonates Admitted in Amhara Region Referral Hospitals of Ethiopia: Retrospective Follow-Up Study. Health Serv Res Manag Epidemiol 2022;9. doi:10.1177\/23333928221117364","DOI":"10.1177\/23333928221117364"},{"key":"2026063005552090000_16.6.e120111.4","unstructured":"World Health Organization . Newborn mortality. 2022. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/newborn-mortality"},{"key":"2026063005552090000_16.6.e120111.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-020-02107-8","article-title":"Derivation and validation of a prognostic score for neonatal mortality in Ethiopia: a case-control study","volume":"20","author":"Mediratta","year":"2020","journal-title":"BMC Pediatr"},{"key":"2026063005552090000_16.6.e120111.6","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1177\/09732179231226026","article-title":"Survival Status and Predictors of Mortality Among Low-birth-weight Neonates in Southern Ethiopia: A Prospective Follow-up Study","volume":"38","author":"Nigussie","year":"2024","journal-title":"Journal of Neonatology"},{"key":"2026063005552090000_16.6.e120111.7","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-019-2227-5","article-title":"Predictors of Neonatal mortality in Neonatal intensive care unit at referral Hospital in Southern Ethiopia: a retrospective cohort study","volume":"19","author":"Orsido","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026063005552090000_16.6.e120111.8","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0213054","article-title":"Risk factors for low birth weight in hospitals of North Wello zone, Ethiopia: A case-control study","volume":"14","author":"Wachamo","year":"2019","journal-title":"PLoS One"},{"key":"2026063005552090000_16.6.e120111.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-054574","article-title":"Morbidity and mortality patterns of preterm low birthweight neonates admitted to referral hospitals in the Amhara region of Ethiopia: retrospective follow-up study","volume":"12","author":"Genie","year":"2022","journal-title":"BMJ Open"},{"key":"2026063005552090000_16.6.e120111.10","doi-asserted-by":"crossref","first-page":"713","DOI":"10.2147\/JMDH.S300362","article-title":"Essential Newborn Care Service Readiness and Barriers in Northwest Ethiopia: A Descriptive Survey and Qualitative Study","volume":"14","author":"Delele","year":"2021","journal-title":"J Multidiscip Healthc"},{"key":"2026063005552090000_16.6.e120111.11","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-024-69680-1","article-title":"Neonatologist staffing is related to the inter-hospital variation of risk-adjusted mortality of very low birth weight infants in Korea","volume":"14","author":"Lee","year":"2024","journal-title":"Sci Rep"},{"key":"2026063005552090000_16.6.e120111.12","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s12098-023-04496-x","article-title":"External Validation of the Neonatal Mortality Risk-2000 Score to Predict In-Hospital Mortality in Neonates Weighing 2000 g or Less","volume":"90","author":"Prasad","year":"2023","journal-title":"Indian J Pediatr"},{"key":"2026063005552090000_16.6.e120111.13","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/S2352-4642(20)30021-3","article-title":"Development and validation of a simplified score to predict neonatal mortality risk among neonates weighing 2000 g or less (NMR-2000): an analysis using data from the UK and The Gambia","volume":"4","author":"Medvedev","year":"2020","journal-title":"The Lancet Child & Adolescent Health"},{"key":"2026063005552090000_16.6.e120111.14","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211362"},{"key":"2026063005552090000_16.6.e120111.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0378-3782(01)00228-6"},{"key":"2026063005552090000_16.6.e120111.16","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/00003246-199301000-00008","article-title":"Predicting mortality risk for infants weighing 501 to 1500 grams at birth: a National Institutes of Health Neonatal Research Network report","volume":"21","author":"Horbar","year":"1993","journal-title":"Crit Care Med"},{"key":"2026063005552090000_16.6.e120111.17","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0235794","article-title":"Prediction of mortality in very low birth weight neonates in Spain","volume":"15","author":"Iriondo","year":"2020","journal-title":"PLoS One"},{"key":"2026063005552090000_16.6.e120111.18","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(96)00236-3"},{"key":"2026063005552090000_16.6.e120111.19","doi-asserted-by":"crossref","DOI":"10.1080\/16549716.2024.2392354","article-title":"Development and validation of a prognosis risk score model for neonatal mortality in the Amhara region, Ethiopia. A prospective cohort study","volume":"17","author":"Asaye","year":"2024","journal-title":"Glob Health Action"},{"key":"2026063005552090000_16.6.e120111.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-023-04319-0","article-title":"Incidence and predictors of mortality among low birth weight neonates in the first week of life admitted to the neonatal intensive care unit in Northwestern Ethiopia comprehensive specialized hospitals, 2022. Multi-center institution-based retrospective follow-up study","volume":"23","author":"Wondie","year":"2022","journal-title":"BMC Pediatr"},{"key":"2026063005552090000_16.6.e120111.21","doi-asserted-by":"publisher","DOI":"10.1111\/j.2517-6161.1996.tb02080.x"},{"key":"2026063005552090000_16.6.e120111.22","doi-asserted-by":"crossref","unstructured":"Hosmer DW , Lemeshow S , Sturdivant RX . Applied Logistic Regression. 3rd edn. Hoboken (NJ): John Wiley & Sons, 2013.","DOI":"10.1002\/9781118548387"},{"key":"2026063005552090000_16.6.e120111.23","doi-asserted-by":"publisher","DOI":"10.1007\/s11135-006-9018-6"},{"key":"2026063005552090000_16.6.e120111.24","doi-asserted-by":"publisher","DOI":"10.4103\/tjem.tjem_182_23"},{"key":"2026063005552090000_16.6.e120111.25","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3181c30fb2"},{"key":"2026063005552090000_16.6.e120111.26","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3"},{"key":"2026063005552090000_16.6.e120111.27","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X06295361"},{"key":"2026063005552090000_16.6.e120111.28","doi-asserted-by":"crossref","unstructured":"Steyerberg EW . Clinical Prediction Models: A Practical Approach to Development, Validation, and Updating. 2nd edn. Cham: Springer, 2019.","DOI":"10.1007\/978-3-030-16399-0"},{"key":"2026063005552090000_16.6.e120111.29","doi-asserted-by":"crossref","unstructured":"Harrell FE . Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis. 2nd edn. Cham: Springer, 2015.","DOI":"10.1007\/978-3-319-19425-7"},{"key":"2026063005552090000_16.6.e120111.30","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9736"},{"key":"2026063005552090000_16.6.e120111.31","doi-asserted-by":"crossref","first-page":"201","DOI":"10.33140\/JPNB.08.02.06","article-title":"Time to Death and its Predictors Among Low-Birth Weight Neonates Admitted in Addis Ababa, Ethiopia","volume":"8","author":"Birhanu","year":"2023","journal-title":"J Pediatr Neonatal Biol"},{"key":"2026063005552090000_16.6.e120111.32","doi-asserted-by":"crossref","unstructured":"Mislu E , Arage MW , Kumsa H , et al . Mortality among low birth weight neonates on parenteral feeding: a prospective follow-up study. Res Rep Neonatol 2024;67\u201384. doi:10.2147\/RRN.S450572","DOI":"10.2147\/RRN.S450572"},{"key":"2026063005552090000_16.6.e120111.33","doi-asserted-by":"crossref","unstructured":"Eshete A , Alemu A , Zerfu TA . Magnitude and risk of dying among low birth weight neonates in Rural Ethiopia: a community-based cross-sectional study. Int J Pediatr 2019.","DOI":"10.1155\/2019\/9034952"},{"key":"2026063005552090000_16.6.e120111.34","doi-asserted-by":"crossref","unstructured":"Gebrekidan AB . Survival Status and Predictors of Mortality among Low-Birth-Weight Neonates Admitted to Neonatal Intensive Care Unit in Suhul General Hospital, Northern Ethiopia: A Retrospective Cohort Study. 2024.","DOI":"10.21203\/rs.3.rs-4219427\/v1"},{"key":"2026063005552090000_16.6.e120111.35","unstructured":"Survival status and predictors of mortality among low birth weight neonates admitted to the neonatal intensive care unit at Jimma Medical Center, Southwest Ethiopia: a retrospective cohort. 2023."},{"key":"2026063005552090000_16.6.e120111.36","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0276291","article-title":"Survival status and predictors of mortality among low-birthweight neonates admitted to KMC units of five public hospitals in Ethiopia: Frailty survival regression model","volume":"17","author":"Debere","year":"2022","journal-title":"PLoS One"},{"key":"2026063005552090000_16.6.e120111.37","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2022.875652","article-title":"Neonatal Mortality Rate and Its Determinants: A Community-Based Panel Study in Ethiopia","volume":"10","author":"Shiferaw","year":"2022","journal-title":"Front Pediatr"},{"key":"2026063005552090000_16.6.e120111.38","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0238629","article-title":"The Kaplan Meier estimates of mortality and its predictors among newborns admitted with low birth weight at public hospitals in Ethiopia","volume":"15","author":"Dessu","year":"2020","journal-title":"PLoS One"},{"key":"2026063005552090000_16.6.e120111.39","doi-asserted-by":"publisher","DOI":"10.7326\/M18-1376"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-120111","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T13:19:19Z","timestamp":1782825559000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-120111"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":39,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,30]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/bmjopen-2026-120111"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-120111","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]}}}