Hypothermia Recovery Times among Neonates Admitted at Pawe General Hospital in Metekel Zone, Ethiopia: Accelerated Failure Time model

Background Neonatal hypothermia remains a major contributor to morbidity and mortality in low-resource settings such as Ethiopia. Understanding how quickly affected neonates recover and what factors delay or accelerate this recovery is essential for improving clinical management. This study aimed to estimate time to recovery from neonatal hypothermia and identify key determinants among neonates admitted to Pawe General Hospital. Methods A retrospective follow-up study was conducted among 490 neonates admitted to the neonatal intensive care unit between January 2020 and December 2022. Time-to-recovery was analyzed using survival methods, and model selection was guided by AIC and BIC criteria. Determinants of recovery were identified using the log-logistic Accelerated Failure Time model. Results The median recovery time was five days. Higher monthly household income (p = 0.010) and female sex (p = 0.023) were associated with shorter recovery times, possibly reflecting better home care resources and biological resilience. Early initiation of breastfeeding within 24 h (p < 0.001) and skin-to-skin contact (p = 0.001) significantly accelerated recovery, highlighting the importance of thermal protection and early feeding practices. Neonates born in health centers (p < 0.001), private facilities (p < 0.001), or at home (p < 0.001) experienced slower recovery, suggesting disparities in immediate newborn care. Preterm birth (p < 0.001), low birth weight (p < 0.001), sepsis (p = 0.007), respiratory distress syndrome (p < 0.001), perinatal asphyxia (p < 0.001), and congenital anomalies (p < 0.001) were associated with prolonged recovery, indicating that clinical complications considerably hinder thermal stabilization. Conclusion Time to recovery from neonatal hypothermia is strongly influenced by socioeconomic factors, early postnatal care practices, place of birth, and neonatal complications. Strengthening early breastfeeding support, promoting skin-to-skin care, and improving quality of immediate newborn care especially for preterm and clinically ill neonates could substantially reduce recovery time. Tailored interventions for high-risk newborns should be prioritized to improve survival and overall neonatal outcomes.