Background Only with education can we create generalized awareness regarding better neonatal care at the societal level. It is well known that the people in many rural and tribal areas across the developing world tend to harbor grave misconceptions regarding pregnancy and neonatal care and lack the knowledge of danger signs. However, the level of parental awareness and its effect on neonatal mortality in the intensive care units in urban areas is often overlooked.

Objectives To assess the effect of parental awareness on the survival outcome of early preterm neonates in a tertiary care center providing referral services.

Methods After taking the approval of the institutional ethics committee, a cross sectional quantitative social research study was conducted. 140 neonates of gestational age ranging between 28–31 weeks and birth weight ranging from 1000 g to 2499 g; of both sexes born in a tertiary care institute of central India and admitted to its neonatal intensive care unit (NICU) within 1 hour of birth were enrolled in the study. Babies of gestational age <28 weeks and >31 completed weeks, birth weight < 1000 g, having lethal congenital malformations, delivery room deaths and those admitted after 1 hr of birth were excluded. The outcome measure was in the form of hospital death or discharge. The awareness of parents of the enrolled neonates, regarding neonatal care and danger signs, was assessed using a single response (yes/no type) 5 questions questionnaire, prepared in local languages. For parents referred from tribal areas, assistance was taken from translators available among relatives or hospital staff. Their responses were correlated with the outcome. The ‘Yes’ answers to 80% of the questions were considered a positive response, which was taken as an indicator of good awareness. Chi-square test and 2 × 2 table were used and the p-value was calculated; p < 0.05 was considered statistically significant. The questions asked were regarding the parents being aware of their baby’s low birth weight or preterm status, its associated complications, benefits of breastfeeding, identification of each of the danger signs, and whether their response to those signs will be to consult a doctor immediately or to try home-based treatment first.

Results Male: female ratio was 0.92:1. The mean Gestational age was 30.27 ± 0.89 weeks, the mean birth weight being 1599.75 ± 282.35 grams. The total mortality in the cohort was 47.1% (66/140). For the mortality group (66), only 42.31% of parents gave a positive response. The survived group (74) was associated with a 58.30% positive response. Thus, the higher the positive response rate greater was the survival (p<0.007).

Conclusions Increased sensitization of parents regarding neonatal danger signs and care practices has a positive impact on neonatal survival, highlighting that parental education is the need of the hour. Improved parental education from the grass-root level in rural areas up to the tertiary care centers in urban areas, regarding safe neonatal health practices, will help in reducing neonatal mortality rate and in achieving target 3 of Sustainable Development Goals.