<![CDATA[Neonatal asphyxia remains a leading cause of early newborn mortality and long-term neurodevelopmental impairment globally. Characterising its contributing factors precisely is crucial for developing targeted preventive strategies, especially in low- and middle-income countries bearing the highest burden. This study synthesises the most consistent factors associated with neonatal asphyxia across diverse geographic settings using recent empirical evidence. A comprehensive systematic review was conducted across Google Scholar, PubMed, and Portal Garuda. Inclusion criteria comprised primary observational studies published in English or Indonesian between 2020 and 2026. From 150 initially identified articles, exactly 10 were ultimately included for final synthesis. Six clinical factors consistently emerged: meconium-stained amniotic fluid (OR: 2.51–5.19), prolonged labour, premature rupture of membranes (AOR=5.19; 95%CI: 2.03–13.26), hypertensive disorders of pregnancy (OR=2.52), prematurity (pooled OR=3.11; 95%CI: 2.24–4.32), and low birth weight (OR: 3.45–4.60). Furthermore, structural barriers, including the absence of skilled birth attendants and living over 10 kilometres from healthcare facilities, significantly amplified asphyxia-related mortality risks. Neonatal asphyxia is highly multifactorial, requiring integrated interventions to improve antenatal risk identification, intrapartum monitoring, and access to skilled obstetric care. These specific identified factors provide a strong evidence-based foundation for prioritising targeted preventive actions in high-burden settings.]]>
