BACKGROUND:
While childbirth is a moment of joy, it can be overshadowed by life-threatening complications that jeopardize neonatal survival. Neonatal near-miss (NNM) cases—infants who survive severe complications—offer insight into the quality of neonatal care. Somalia has one of the world’s highest neonatal mortality rates (≈ 37 deaths per 1,000 live births), reflecting major gaps in maternal and child health. This study identified determinants of NNM among neonates admitted to SOS Mother & Child Hospital, Banadir, Somalia.

METHODS:
An unmatched case–control study was conducted from December 2024 to April 2025 at SOS Mother & Child Hospital. A total of 243 NNM cases and 730 healthy controls were included. Cases were identified using the Centro Latinoamericano de Perinatología (CLAP) pragmatic and management criteria. Data were collected via structured questionnaires and record reviews, and analyzed with SPSS v25. Logistic regression identified independent predictors of NNM.

RESULTS:
Significant predictors included lack of maternal (aOR 2.61) and paternal education (aOR 3.64), monthly income < 100 USD (aOR 2.82), short birth interval < 24 months (aOR 1.97), no antenatal care (aOR 6.25), history of stillbirth (aOR 4.35), obstetric complications (aOR 4.46), preterm/post-term birth (aOR 1.89), prolonged labor (aOR 3.58), home delivery (aOR 4.76), maternal chronic illness (aOR 3.37), male sex (aOR 1.86), and low birth weight (aOR 9.34).

CONCLUSIONS:
Neonatal near-miss remains a critical public-health issue in Somalia, shaped by socioeconomic, obstetric, and neonatal factors. Expanding maternal education, antenatal care, and skilled birth attendance—along with strengthening facility-based delivery—are essential to reduce preventable neonatal complications. Targeted policy and investment in maternal–newborn health are urgently needed.