Background: Neonatal asphyxia (NA) remains a major global health concern, especially in low-income settings. With the goal to prevent its occurrence, our objective was to determine predictors and hospital outcomes of NA within a Cameroonian context.

Methods: A case-control study was conducted among pregnant women attending three major health-facilities of the Southwest Region of Cameroon, from January-April 2023. Cases were defined as neonates at 5th minute with Apgar-score<7 versus controls with Apgar-score≥7. Logistic regression was performed to determine predictors of NA, with 95% confidence interval [CI].

Results: Incidence of NA was 75.5 per 1000 live births, and predictors of NA were prolonged labor (AOR=4.01 [1.19-13.55]), premature rupture of membranes (AOR=8.98 [2.97-27.14]), acute foetal distress (AOR=33.91 [9.29-29.68]), gestational-age >42 weeks (AOR=5.99 [1.37-26.32]), (n<4) of ANC-visits (AOR=12.76 [5.49-123.72]) and neonatal resuscitation (AOR=86.99 [29.16-259.47]). The most common outcome was hypoxic-ischemic encephalopathy (88.7%); mean duration of hospitalization was 6.58 days; and 77.4% asphyxiated were discharged without any apparent neurologic sequelae, while 21% (13) of asphyxiated neonates died during hospitalization.

Conclusion: Incidence of NA is high, driven by acute foetal distress, premature rupture of membranes, prolonged gestational-age and labour, with the most common hospital outcome being hypoxic-ischemic encephalopathy.