Burden of neonatal pneumonia and risk factors for severe disease in low - and middle - income country.

Objectives: To determine morbidity, mortality, and risk factors of severe disease requiring invasive mechanical ventilation (IMV) in neonates with pneumonia in rural Vietnam. Methods: A retrospective study was conducted and included all neonates (<28 days) admitted with pneumonia between January and December 2024. Demographics, clinical features, and laboratory results were extracted from standardized patient charts. Univariable and multivariable logistic regression were used to identify independent risk factors for IMV. Results: Of 1,034 admissions, 612 (59.2%) met pneumonia criteria; mortality rate was 0.2%. Median age at admission was 17 days (IQR 12-23), and 61.6 % were boys. Preterm birth and low birth weight occurred in 4.6% and 6.4% of cases, respectively. Tachypnoea (96.1%), wheeze (93.0%), and signs of respiratory distress (37.7%) were predominant. Abnormal neutrophil counts were observed in 30.2%, and 5.2% had C-reactive protein (CRP) ≥10 mg/L. Independent risk factors for IMV were younger age (adjusted odds ratio [aOR] 0.88 per day; 95% CI 0.85-0.92), neurological symptoms (aOR 24.0; 95% CI 4.07-141.67), and CRP ≥10 mg/L (aOR 3.23; 95% CI 1.22-8.52). Conclusions: Pneumonia remains a major cause of neonatal morbidity in rural Vietnam, though mortality is low. Younger age, neurological compromise, and elevated CRP identify neonates at greatest risk for requiring IMV. Incorporating these factors into admission triage may streamline escalation of care and optimize resource allocation in neonatal units.