TITLE:
Maternal and Neonatal Determinants of Admissions to the Neonatal Intensive Care Unit at Kirehe District Hospital, Rwanda
AUTHORS:
Ernest Muhirwa, Betsy Cheriro, Elizabeth Kiilu
KEYWORDS:
Neonatal Intensive Care Unit (NICU), Neonatal Admissions, Maternal Determinants, Neonatal Risk Factors, Prematurity, Neonatal Infections, LBW, Rwanda
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.16 No.2,
March
23,
2026
ABSTRACT: Background: Neonatal Intensive Care Unit (NICU) admissions remain a major public health concern, in low-resource settings. Identifying maternal and neonatal determinants of NICU admissions is essential for strengthening preventive and clinical interventions to improve neonatal survival and health outcomes. Design and Methods: A cross-sectional study was conducted at Kirehe District Hospital, Rwanda from February to March 2024. All neonates aged ≤28 days who were either born at the hospital or referred from other facilities were included. Maternal and neonatal data were extracted from medical records. Descriptive statistics summarized characteristics, while chi-square tests assessed bivariate associations. Two hierarchical multivariable logistic regression models were fitted: Two hierarchical logistic regression models were fitted: Model 1 included maternal and delivery-related factors, and Model 2 additionally incorporated neonatal clinical diagnoses. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported, with statistical significance set at p Results: Among 340 neonates (281 inborn and 59 referred), 39.7% (n = 135) were admitted to the NICU, including 17.4% referrals. In Model 1, independent maternal determinants of NICU admission included maternal age 20 - 34 years (aOR = 2.1, 95% CI: 1.05 - 4.21) and ≥35 years (aOR = 4.12, 95% CI: 1.88 - 9.02), gestational diabetes (aOR = 5.8, 95% CI: 2.65 - 12.70), maternal infection (aOR = 3.2, 95% CI: 1.42 - 7.21), multiple gestations (aOR = 4.8, 95% CI: 1.91 - 12.05), and cesarean delivery (aOR = 2.2, 95% CI: 1.00 - 4.85). In Model 2, significant neonatal predictors included preterm birth (aOR = 4.5, 95% CI: 2.10 - 9.61), low birth weight (aOR = 5.8, 95% CI: 3.02 - 11.14), birth asphyxia (aOR = 3.25, 95% CI: 1.11 - 9.41), respiratory distress syndrome (aOR = 12.0, 95% CI: 6.00 - 24.01), congenital anomalies (aOR = 2.75, 95% CI: 1.20 - 6.32), and neonatal sepsis (aOR = 8.0, 95% CI: 3.80 - 16.57). Conclusion: NICU admissions at Kirehe District Hospital, Rwanda are driven by a combination of maternal risk factors and neonatal clinical conditions. Strengthening antenatal care, early identification of high-risk pregnancies, and enhancing neonatal emergency preparedness are critical to reducing preventable NICU admissions and advancing neonatal survival and outcomes in rural, resource-constrained settings.