Objectives. To examine the association between system alignment among Nurse-Family Partnership (NFP) home visitors and other community service providers and maternal behaviors and birth outcomes among NFP clients. Methods. NFP implementation data from 2015 to 2021 were matched to the 2018 to 2021 NFP Collaboration Panel Survey (n = 102 690). We used Poisson-based general estimating equations to examine a measure of cross-sector collaboration (based on relational coordination and structural integration) and the relationship with prenatal smoking cessation, breastfeeding, low birth weight, and preterm birth after adjustment for client-, nurse-, and agency-level covariates. Results. Stronger coordination with women's care providers (relative risk [RR] = 1.010; 95% confidence interval [CI] = 1.00, 1.02) and greater integration with mental health providers (RR = 1.002; 95% CI = 1.00, 1.00) were slightly positively associated with initiation of breastfeeding. The slight positive association with greater integration with mental health providers was sustained for continued breastfeeding at 6 months postpartum (RR = 1.004; 95% CI = 1.00, 1.01). System alignment was not related to prenatal smoking cessation, low birth weight, or preterm birth. Conclusions. Future implementation studies should explore whether strategies to increase system alignment result in changes in quantitative measures of cross-sector collaboration and meaningful improvement in maternal and child outcomes at a population level. (Am J Public Health. 2026;116(S3): S181-S191. https://doi.org/10.2105/AJPH.2026.308457).

Pharmacologic treatment is widely used for managing gestational diabetes mellitus (GDM). However, evidence remains limited on the comparative effectiveness and safety across different drug classes for GDM. This study aims to compare the efficacy and safety of pharmacologic treatments for GDM using network meta-analysis of randomised controlled trials (RCTs). We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science up to May 16, 2025 to identify trials evaluating glucose levels and maternal or neonatal complications in GDM patients using any pharmacologic agents, e.g., insulin, biguanides, sulfonylureas, α-glycosidase inhibitors, sodium-glucose cotransporter-2(SGLT-2) inhibitors, dipeptidyl peptidase IV(DPP-IV) inhibitors or Glucagon-like peptide-1receptor (GLP-1 RAs) versus standard care. We used random-effects model for both pairwise meta-analyses and frequentist network meta-analyses and applied the Confidence in Network Meta-Analysis (CINeMA) framework to assess the certainty of evidence. Seventy-three articles were eligible, comprising 71 trials in which 14 877 participants were enrolled and seven drug classes assessed. All subsequent effects refer to comparisons with standard care. Because of their moderate to high evidence of certainty, sulfonylureas were established as the most effective drugs used for lowering fasting glucose (mean difference [MD]: -0.33 mmol/L; 95% confidence interval [CI]: -0.55 to -0.1), followed by insulin (MD: -0.3 mmol/L; 95% CI: -0.4 to -0.21) and biguanides (MD: -0.2 mmol/L; 95% CI: -0.28 to -0.12). Biguanides were the most effective drugs used to control haemoglobin A1c (MD: -0.1%; 95% CI: -0.16 to -0.03), but their use was associated with increased adverse events leading to low birth weight among infants (OR: 2.04; 95% CI: 1.04-4.01). Insulin (OR: 0.51; 95% CI: 0.34-0.75), biguanides (OR: 0.39; 95% CI: 0.26-0.59), and sulfonylureas (OR: 0.5; 95% CI: 0.31-0.79) use could decrease the risk of macrosomia. Sulfonylureas were found to be more easily get premature delivery and neonatal hypoglycaemia than biguanides; evidence regarding their impact on low birth weight and long-term safety remains lacking. Insulin use provides significant benefits in achieving glycaemic control and minimising maternal and foetal complications, and it has a favourable overall safety profile. Biguanide use may be associated with an increased risk of low birth weight, warranting careful consideration and thorough counselling for shared decision-making. Currently, insufficient evidence supporting the efficacy and safety of sulfonylureas, α-glycosidase, DPP-IV, and SGLT-2 inhibitors; and GLP-1 RAs in GDM management is available.

To evaluate the associations between advanced parental age and perinatal risks in twins. We analyzed 7514 twin pairs conceived through in vitro fertilization. The exposure was advanced parental age (≥35years), analyzed separately for mothers and fathers. Primary outcomes included birth weight discordance, small for gestational age, large for gestational age, macrosomia, low birth weight, very low birth weight, preterm birth, very preterm birth, and extremely preterm birth. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using logistic regression. Additionally, parental age was analyzed both as a categorical variable and with a restricted cubic spline. The combined effect of advanced age in both parents was further evaluated. Advanced paternal age (≥35years) was associated with increased odds of birth weight discordance (adjusted OR, 1.20; 95% CI, 1.01-1.42). A graded dose-response association was evident (p for trend=0.026), with adjusted ORs for birth weight discordance progressively increasing across paternal age categories: 1.02 (95% CI, 0.83-1.25) for ages 30-34, 1.18 (95% CI, 0.91-1.52) for ages 35-39, and 1.41 (95% CI, 1.02-1.96) for ages ≥40years, all compared to the <30years reference group. Restricted cubic spline analysis identified 37years as a threshold beyond which paternal age significantly elevated birth weight discordance risk. Similarly, advanced maternal age (≥35years) was significantly associated with increased small for gestational age odds (adjusted OR, 1.21; 95% CI, 1.04-1.41), with a significant trend (p for trend=0.012) and a restricted cubic spline-derived threshold at 30years. When both parents were over 35, the odds of birth weight discordance (adjusted OR, 1.37; 95% CI, 1.15-1.63) and small for gestational age (adjusted OR, 1.30; 95% CI, 1.13-1.50) were significantly elevated compared to both being under 35. Advanced parental age was associated with elevated risks of birth weight discordance and small for gestational age in twins, suggesting it as a contributing factor to perinatal risk.

Introduction: Premature and Low-Birth-Weight (LBW) neonates demonstrate underdeveloped organs, including low nephron counts, rendering them susceptible to renal impairment subsequently. Therefore, early and accurate detection of kidney dysfunction is important for management. Traditionally, serum creatinine is used for estimating Glomerular Filtration Rate (GFR), which maternal levels and neonatal muscle mass may influence. Therefore, cystatin-C, a non protein-bound, lowmolecular-weight marker, is tested for this study for the early detection of renal dysfunction. Aim: To identify creatinine or cystatin-C as a better marker in premature and LBW neonates. Materials and Methods: This case-control study was conducted from June to October 2022 at the SRM Medical College Hospital, Tamil Nadu, India. The participants were from Chengalpattu district, including 63 rural and 47 suburban pregnant women. The primary inclusion criteria were neonates diagnosed as premature and LBW, with a sample size of 53 neonates per group. A 3-5 mL of venous and cord blood samples of neonates were collected, serum was separated and stored at -20°C to estimate creatinine, cystatin-C levels and GFR. The results were expressed as mean values, and statistical significance was assessed using the Student’s t-test, with a p-value &lt;0.05 considered statistically significant. Results: Cystatin-C were found to be 1.9±0.8 mg/dL and significantly higher in cord blood samples in comparison with the control. The cystatin-based eGFR value was found to be 91.4±43.2 mL/min and 149±35.4 mL/min for venous and cord blood samples, respectively. Whereas only cystatin-C was statistically significant in venous blood samples. However, GFR based on creatinine and cystatin-C was significantly decreased in both venous and cord blood samples. Conclusion: The AUC for cystatin-C in cord blood samples was found to be 0.7, indicating its reliability compared to creatinine. Moderate accuracy observed indicates the need for a larger number of samples for the establishment of a diagnostic marker. Thereby, for cystatin-C to be used as a marker for renal dysfunction further validation is required.

Effect of kangaroo mother care initiated within the first 24h in preterm or low birth weight infants: A systematic review and meta-analysis.

To evaluate the efficacy of oral Lactobacillus rhamnosus GG (LGG) in reducing neonatal enterocolitis (NEC), sepsis and mortality in very low birth weight (VLBW) infants. This open-label randomized controlled trial included enterally-fed VLBW infants with gestational age ≤ 32weeks; those with gastrointestinal anomalies, severe birth asphyxia (APGAR score < 3 at 5min), cyanotic congenital heart disease, and those not started on feeds by 14days of life were excluded. Participants were randomized to receive either no probiotic (control) group, or probiotic (LGG; intervention) group. The intervention group received the first dose of LGG (probiotic) at feed initiation and was continued till 35weeks of corrected gestational age. The control group received only breast milk. Clinical outcomes (mortality, NEC, sepsis) were compared in both groups during hospital stay. A total of 236 infants were enrolled. The primary composite outcome of sepsis, NEC or mortality was seen in 35 (30.4%) and 33 (27.2%) infants, respectively in the LGG and control groups (RR 0.85; 95%CI 0.48-1.50, P = 0.592). The mean (SD) time to reach full feeds was 11.9 (4.2) and 12.0 (5.5) days in the LGG and control groups, respectively; P = 0.561. The mean (SD) time to regain birth weight was 13.5 (3.9) and 13.6 (3.9) days in the LGG and control groups, respectively (P = 0.982). There was no significant difference in duration of hospital stay, duration of mechanical ventilation, or duration of antimicrobial therapy between the two groups (P > 0.05). Use of LGG as single component probiotic in VLBW infants did not confer any significant benefit on the composite outcome of mortality, sepsis or NEC. Clinical Trial Registry of India; Ref. No. CTRI/2021/03/031724 dated Mar 03, 2021.

Childhood maltreatment and pregnancy-related reproductive health in middle adulthood: a prospective investigation.

Vitamin D deficiency during pregnancy is common, especially in low- and middle-income countries. The objective of the study was to determine the prevalence of vitamin D deficiency among pregnant women of Bangladesh and its association with adverse maternal and fetal outcomes. The cross-sectional study was conducted among 420 pregnant women admitted to the department of Obstetrics and Gynecology of Popular Medical College Hospital for delivery from July 2019 to June 2022. Data collection was done through face-to-face interview using a semi-structured case record form and laboratory tests. A logistic regression model was constructed to determine the association between maternal vitamin D status and pregnancy outcomes. Prevalence of vitamin D deficiency [serum 25(OH)D <30 nmol/L] among pregnant women was 11.7% and vitamin D insufficiency [serum 25(OH)D 30-75 nmol/L] was 77.6%. In logistic regression model, vitamin D deficiency was not significantly associated with gestational diabetes mellitus (aOR 2.32, 95% CI 0.54, 12.0), preeclampsia (aOR 2.94, 95% CI 0.75, 14.6), preterm labor (aOR 2.41, 95% CI 0.98, 6.25), low birth weight (aOR 2.04, 95% CI 0.81, 5.30), intrauterine growth retardation (aOR 2.55, 95% CI 0.51, 18.7) and low APGAR score (aOR 1.51, 95% CI 0.24, 12.0). A large proportion of the pregnant women had a suboptimal level of vitamin D. However, no significant association between vitamin D deficiency and pregnancy outcome was found in the study.

Hypertensive disorders of pregnancy represent a major cause of maternal and fetal morbidity and mortality. Despite primary aldosteronism (PA) being the most common cause of secondary hypertension, there is limited data on pregnancy complications in patients with PA. We conducted an international survey across 5 Hypertension Centers in Europe to gather data on maternal and neonatal complications in women diagnosed with PA from 2000 to 2022. We included 102 women aged 18 to 45 years at PA diagnosis who were pregnant either after or <1-year before the diagnosis of PA. The first eligible pregnancy for each patient was included. Overall, 56% of pregnancies were complicated, with the most frequent complications being maternal preeclampsia (36%), preterm birth (30%), low birth weight (30%), and neonatal intensive care admission (22%). Hypokalemia occurred in 31% of pregnancies. Pregnancies occurring before PA diagnosis presented a poorer blood pressure control and were associated with higher rates of overall, maternal, and fetal/neonatal complications compared with pregnancies in patients with an established PA diagnosis. Independent predictors of complications included uncontrolled blood pressure values during pregnancy (odds ratio [OR], 7.05), undiagnosed PA (OR, 4.37), North/Black African ethnicity (OR, 3.69), a higher body mass index (OR, 1.09), and treatment with a higher number of antihypertensive drugs at PA diagnosis (OR, 2.18). PA is associated with a high rate of pregnancy-related complications, predominantly preeclampsia. Undiagnosed PA during gestation significantly increases the risk of adverse outcomes. Early identification and optimized hypertension control in women with PA are critical to improve maternal and fetal outcomes.

Evaluation of the effectiveness of a screening program as compared to usual care in identifying patients with post-partum depression: a cohort study of 20,448 births in Bizkaia (Spain).

Sickle Cell Disease: Can genetic variability influence pregnancy outcomes?

To map evidence linking maternal exposure to ambient air pollution during pregnancy and around birth when reported, with perinatal outcomes. We searched PubMed, Embase and Web of Science for studies evaluating air quality index, fine particulate matter less than 2.5 μm, nitrogen dioxide or ozone in relation to birth weight, preterm birth, stillbirth, neonatal mortality, congenital anomalies or neonatal intensive care unit admission. Two reviewers screened and extracted data independently. We performed a narrative scoping synthesis; pooled odds ratios came from included meta-analyses. Twenty studies were included: 12 cohort studies, 3 case-control studies, 4 systematic reviews with meta-analyses and 1 cross-sectional study. Most assessed in utero exposure by trimester or pregnancy averages; a few assessed exposure around delivery, and none primarily evaluated preconception exposure. Fine particulate matter less than 2.5 μm showed the most consistent associations with lower birth weight and higher preterm birth risk. Nitrogen dioxide was also associated with preterm birth and reduced birth weight. Ambient air pollution, especially fine particulate matter less than 2.5 μm and nitrogen dioxide, is associated with adverse perinatal and neonatal outcomes and supports exposure reduction during pregnancy and better research on critical exposure windows.

To investigate if providing additional parenteral amino acids to extremely low birthweight (ELBW) infants improves neurocognitive function, lean mass, and muscle strength at early school age, without adverse effects on blood pressure and general health. Multicenter, 2-arm parallel, double-blinded randomized trial of an additional 1 g/d of parenteral amino acids for 5days after birth or placebo (1:1 ratio), with follow-up at 6 to 7years old' corrected age. The primary outcome was survival free of neurocognitive impairment, defined as a standard score more than 1 SD below the age-corrected mean in 1 or more National Institutes of Health Toolbox cognitive and motor tests. Fifteen secondary outcomes included measures of motion perception, numeracy, body size and composition, blood pressure, and emotional-behavioral and psychosocial health. Of 309 eligible children, 280 (153 [55%] girls) were assessed at school age. The proportion surviving without neurocognitive impairment was similar between the amino acid and placebo groups (21% vs 23%; adjusted risk difference [aRD], -5.0; 95% CI, -12.8 to 2.7; P = .21). Children in the amino acid group had lower muscle strength than placebo group (relative handgrip strength z-score: mean, -0.73 [SD, 1.01] vs mean, -0.33 [SD, 1.17]; adjusted mean difference, -0.39; 95% CI, -0.65 to -0.13) and may have had increased risk of low psychosocial functioning (26% vs 18%; aRD, 10.7; 95% CI, -1.3 to 22.6). Other secondary outcomes were similar between groups. In ELBW infants, providing an additional 1 g/d of parenteral amino acids for 5days after birth has little to no effect on survival without neurocognitive impairment at school age and may have adverse effects on strength and psychosocial functioning.

ObjectivesThis study aims to investigate the correlation of Doppler ultrasound indices of umbilical artery (UA), middle cerebral artery (MCA), cerebro-placental ratio (CPR), length of umbilical cord (UC) coiling, and birthweight, as well as the predictors of these parameters for small for gestational age (SGA).MethodsThis cross-sectional study was conducted between June 2022 and June 2024 at Hue University of Medicine and Pharmacy Hospital, Vietnam. The study enrolled 337 full-term primigravida with uncomplicated singleton pregnancies who underwent Doppler transabdominal ultrasound between 37+0 and 41+0 weeks of gestation to assess fetal Doppler indices and length of UC coiling. Birthweight was collected at delivery.ResultsThe study found significant differences relating birthweight and resistance index of umbilical artery (RI-UA) between abnormal and normal coiling groups (3028.83 ± 469.81 vs 3129.52 ± 378.82 and 0.604 ± 0.087 vs 0.579 ± 0.073). There was a significantly weak negative correlation between RI of umbilical artery Doppler and birth weight (r = -0.178). Additionally, a significantly weak positive correlation coefficient between CPR and birth weight (r = 0.111) was found. Length of umbilical cord coiling had a weak positive correlation with pulsatility index of uterine artery (PI-UA). RI of umbilical artery Doppler helps in predicting the small gestational age at birth with AUC: 0.72 (0.57-0.87).ConclusionRI-UA and birthweight were significantly different between abnormal and normal coiling pregnancies. The higher RI-UA is more related to lower birthweight. RI-UA helps in predicting the small gestational age at birth better than other parameters.

Objectives: To evaluate the association between maternal serum alpha-fetoprotein (MSAFP) levels during the second trimester and low birth weight (LBW) incidence, at Sunpasitthiprasong Hospital. Materials and Methods: This retrospective cohort study included 1,937 pregnant women who underwent chromosomal abnormality screening between June 2021 and May 2025. Data from medical records included maternal baseline characteristics, antenatal history, quadruple test results, and delivery outcomes. Univariable and multivariable analyses were performed using logistic regression. Predictive performance of MSAFP for LBW was assessed by receiver operating characteristic curve analysis.Results: The mean age of pregnant women was 28.5 ± 5.4 years. Birthweight less than 2,500 grams was observed in 10.9% of infants. The quadruple test was positive in 7.4% of cases. The median MSAFP levels were 34.36 ng/mL (interquartile range, IQR 26.94, 45.30), converting to 1.01 multiple of median (MoM) (IQR 0.83, 1.28). MSAFP levels were significantly higher in the LBW group compared to the non-LBW group (median 37.33 vs 34.12 ng/mL). In multivariable analysis, MSAFP in ng/mL, MoM, and &gt; 2.0 MoM was significantly associated with LBW (adjusted odds ratios 1.01, 1.34, and 2.52 respectively). However, serum AFP demonstrated low predictive performance for LBW (area under the curve = 0.566). Conclusion: MSAFP levels were significantly correlated with LBW, with higher levels observed in pregnancies with LBW. However, its predictive performance was low, limiting clinical utility. Elevated MSAFP may indicate risk to LBW but should be evaluated alongside other maternal and biochemical factors for effective risk assessment.

Birth weight is a reliable indicator of intrauterine growth and an important predictor of neonatal survival, growth, and long-term development. Globally, approximately 15.5% of live births are low birth weight, and nearly 10% are macrosomic (high birth weight), with a substantial proportion of these cases occurring in sub-Saharan Africa. Birth weights outside the normal range of 2,500-4,000g are considered abnormal and are associated with increased risks of neonatal and maternal complications. Ethiopia is similarly affected by the growing burden of abnormal birth weight. A retrospective cross-sectional study design using secondary HDSS data collected from 2015 to 2022 was employed. This design was considered appropriate because the study aimed to develop machine learning models using routinely collected surveillance data to predict abnormal birth weight and identify associated factors, rather than to establish causal relationships. All singleton births were included, and those with missing birth weight data were excluded. Six machine learning algorithms identified from the literature were built and compared to identify the best-performing model for predicting abnormal birth weight. Prior observational studies and expert opinion were used to select the candidate features for all models. The synthetic minority oversampling technique (SMOTE) was used to manage the imbalance in the dataset. The dataset was split into training (80%, n = 9,242) and testing (20%, n = 2,311) subsets for model development and evaluation. Hyper-parametric tuning was performed using grid search combined with 10-fold cross-validation to optimize model performance and reduce over-fitting. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC), accuracy, precision, F1-score, and Kappa. Feature importance analysis was done using Shapley Additive explanation (SHAP) values. The Descriptive analysis of 11,553 singleton births showed that 10.78% of the newborns had high birth weight (HBW) and 9.28% had low birth weight (LBW). The eXtreme Gradient Boosting (XGBoost) model performed best by achieving an AUC of 0.835, an accuracy of 0.72, a precision of 0.67, an F1-score of 0.63, a recall of 0.54, and a kappa of 0.52 for abnormal birth weight prediction. The feature importance analysis showed that the top predictors for the low birth weight (LBW) include maternal educational status, age at first delivery, and antenatal care (ANC) visit, while high birth weight (HBW) was strongly predicted by antenatal care (ANC) visit, maternal literacy status, age at first delivery, and maternal education. Machine learning models showed moderate performance in predicting abnormal birth weight using HDSS surveillance data. Maternal educational characteristics, age at first delivery, and ANC utilization were identified as important predictive features. However, the findings should be interpreted cautiously because the model identified predictive associations rather than causal relationships. Further studies incorporating additional maternal clinical and nutritional variables, as well as external validation datasets, are recommended to improve predictive performance and generalizability.

Independent and combined effects of first-trimester elevated fasting blood glucose and high-normal blood pressure on pregnancy outcomes.

Women racialized as Black and/or Hispanic have high rates of adverse perinatal outcomes due to systemic racism. It is unknown if rates are higher among Black and/or Hispanic women with disabilities, who may experience additional barriers to perinatal healthcare, including disability-based discrimination (i.e., ableism). Therefore, we examined the associations between maternal disability and preterm birth (< 37 weeks' gestation), low birthweight (< 2500g), small for gestational age (< 10th percentile), and attendance at a postpartum health visit among Black and/or Hispanic women. We conducted a cross-sectional study of Pregnancy Risk Assessment Monitoring System (PRAMS) data from participants who identified as Black and/or Hispanic between 2018 and 2019 across 22 jurisdictions (N = 9,034). Maternal disability was the primary exposure measured using the Washington Group-Short Set of Questions on Functioning, which asks respondents to rate their level of difficulty seeing, hearing, walking or climbing steps, remembering or concentrating, self-care, and communicating. Response options include "no difficulty," "some difficulty," "a lot of difficulty," and "I cannot do this at all." We examined differences in perinatal outcomes by overall disability status, disability severity, and disability type. We adjusted for demographic and clinical factors using multivariable logistic regression. The prevalence of disability was 7.7%. There were no significant differences in preterm birth or low birthweight by maternal disability. Participants with any disability were significantly less likely to have a small for gestational age infant (adjusted odds ratio [aOR] = 0.56, 95% confidence interval [CI] = 0.37, 0.86) and to attend the postpartum visit compared to participants without disabilities (aOR = 0.38, 95% CI = 0.25, 0.57). We also found that as the level of self-reported difficulty increased, the odds of attending a postpartum health visit significantly decreased. Participants who reported blindness/low vision, cognition disability, communication disability, or multiple disabilities had significantly lower odds of attending the visit compared to participants without disabilities. Maternal disability was associated with lower odds of attending a postpartum health visit among Black and/or Hispanic participants in PRAMS, while small for gestational age differed by disability status and severity. Future research should identify barriers to postpartum healthcare for Black and/or Hispanic women with disabilities to inform culturally and disability-specific interventions.

Objective: To evaluate the anatomical treatment outcomes of intravitreal aflibercept in infants with severe Stage 3 retinopathy of prematurity (ROP). Study Design: Prospective cohort study. Place and Duration of Study: LRBT Tertiary Teaching Eye hospita , Karachi, 06 months (August 2025 to January 2026). Patients and Methods: This prospective cohort study was conducted at a tertiary care eye hospital. Sixteen infants (32 eyes) with gestational age &lt;34 weeks and birth weight &lt;2000 g, who had treatment-requiring Stage 3 ROP received intravitreal aflibercept (0.4 mg/0.01 mL). Outcomes were assessed at 1–2 weeks, 4–6 weeks, and 3 months. Continuous variables were summarized as mean ± SD and categorical variables as frequencies and percentages. Descriptive statistics were used. Because of the small sample size and the low number of unfavorable outcomes, any univariate analyses were considered exploratory. Results: At 3 months, complete regression was achieved in 26 eyes (81.3%), partial regression in 4 eyes (12.5%), and no change in 2 eyes (6.2%). No eye showed disease progression or recurrence during follow-up. Two eyes (6.2%) belonging to one infant required rescue laser photocoagulation. Mild subconjunctival hemorrhage occurred in 4 eyes (12.5%); no major ocular or systemic adverse events were observed. Exploratory analysis shows that lower gestational age, lower birth weight, Zone I disease, and aggressive ROP were more in infants with unfavorable outcomes. Conclusion: Intravitreal aflibercept appears to be a safe and effective option for the initial management of severe Stage 3 ROP, with high anatomical regression and few short-term complications. Larger studies with longer follow-up are needed to confirm longterm ocular and systemic safety. Kewords: Aflibercept; Infant; Intravitreal injections; Retinopathy of prematurity; Treatment outcomes.

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. An institution-based prospective follow-up study. 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. 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. 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). 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 <32 weeks and 32 weeks to <37 weeks, and birth weights of <1000 g and 1000-1499 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. 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.