Background: In Ethiopia, though a significant reduction in under-five mortality was noticed within the last fifteen years, still the neonatal mortality accounting for 47% of under-five mortality. Neonatal factors like birth size, birth rank and birth interval and maternal complication during labour as well as health seeking behavior are the potential determinants of neonatal mortality. The aim of this study was to determine neonatal survival in Aroresa District, Southern Ethiopia.

Methods: A community based prospective follow up study was conducted among a cohort of term pregnant mothers and neonates delivered from January 1/2018 to March 30/2018. A total of 586 term pregnant mothers were selected with a multistage sampling technique and 584 neonates were followed-up for a total of 28 days, with 12 twin pairs. Data were coded, entered cleaned and analyzed using SPSS version 22. Kaplan–Meier survival curve was used to show pattern of neonatal death in 28 days.  Independent and adjusted relationships of different predictors with neonates’ survival were assessed with Cox regression model. The risk of mortality was explored and presented with hazard ratio and 95% confidence interval and P-value less than 0.05 were considered as significant.

Result: The overall neonatal mortality was 41 per 1000 live births. Hazards of neonatal mortality was high for neonates with complication (AHR=3.643; 95% CI, 1.36-9.77), male neonates (AHR=2.71; 95% CI, 1.03-7.09), small sized baby (AHR=3.46; 95% CI, 1.119-10.704), neonates who had initiated EBF after one hour (AHR=3.572; 95% CI, 1.255-10.165) and with mothers who had no postnatal care (AHR=3.07; 95% CI, 1.16-8.12).

Conclusion: Neonatal mortality in study area 4.1% which is high and immediate action should be taken towards achieving Sustainable Development Goals. To improve neonatal survival, promotion of maternal service utilization, essential newborn care and early initiation of exclusive breast feeding were recommended.