Background: Prematurity is an important risk factor for survival of neonates and associated with increased perinatal mortality. Preterm birth rate is increasing worldwide and great disparities exist in quality, access to care and survival rates across countries. Even though, the majority of the causes can be effectively prevented by providing adequate medical care during pregnancy and childbirth with access to proven and inexpensive care; Itis a leading cause of neonatal morbidity and mortality. Preterm survival rate and factors affecting among admitted neonates had not been studied in the study area.

Methods: Institution based retrospective cohort study was conducted among 535 preterm Neonates admitted at Debretabor General Hospital from January 1, 2014-December 30, 2017. Data were entered into EPi-data 4.2.0.0 and exported to STATA version 14 statistical package software for analysis. Kaplan-Meier survival analysis and Log-rank test were used to look at statistical differences between categories of variables. Cox proportional hazard model was used to identify independent predictors of preterm survival. P-value 0.05 was inferred statistically significant. The goodness of fit of the final model was done by Cox-Snell residuals test.

Results: In this study, the preterm survival rate was 68.8 %(688 per 1000 admitted preterm neonate survive).Preterm neonates  with a gestational age of less than 32 weeks of gestation (AHR=1.74; 95%CI: 1.24, 2.46), Male sex (AHR=1.38; 95%CI: 1.01, 1.90), Borne from preeclampsia/ Eclampsia mothers (AHR=1.95; 95%CI: 1.13, 3.36), Extremely Very low birth weight (AHR=2.94, 95%CI: 1.05, 8.24),Respiratory distress syndrome (AHR=1.70, 95%CI: 1.20, 2.41) were statically significant predictors of preterm death.

Conclusion and Recommendations: Preterm neonatal survival rate was low. Survival of preterm neonate was lower for gestational age less than 32 weeks, male neonates, preterm borne from preeclampsia /eclampsia mother, extremely very low birth weight, and respiratory distress syndrome. The study suggests managing maternal complications, low birth weight, prematurity; and ensuring a continuum of care to increase survival of preterm neonates.

Keywords: Preterm Birth, Neonatal Survival, Ethiopia