Introduction Neonatal death has a complex causal framework and improvement of this health indicator is quite gradual. The aim of present study was evaluation of neonatal death risk factors in a substantial sample of Iranian neonates in a part of rural areas by using a relatively new design and modern analytic technique.

Methods and Materials This study was conducted as a nested case-control study and the study cohort was all of the neonates who were born in rural area of Kohgiluyeh and Boyerahmad province (South of Iran) during one calendar year (from March 2006 to March 2007). Due to occurrence of 97 cases of neonatal death in the studied cohort (6900 newborn), 97 controls were selected, resulting in a total sample size of 194.

Results Univariate conditional logistic regression for each variable was performed and any risk factors that showed marked association (p value <0.2) was selected for the next step analysis. In the final model (conditional logistic regression) LBW (AOR=8.92), C-section (AOR=9.17), birth rank more than 3 (AOR=6.12), mother illiteracy (AOR=3.96) and birth spacing <24 months (AOR=5.45) showed significant statistical association (p value <0.05) with neonatal mortality.

Conclusion This study has identified; LBW, C-section, birth spacing <24 months, mother illiteracy and birth rank more than 3 as potential risk factors for neonatal mortality.