Globally, 17.7% of under-5 mortality and 36.1% of neonatal mortality occur due to preterm birth complications. Ethiopia is one of the top 10 countries with the highest neonatal mortality. Data on survival status and predictors of mortality among preterm neonates in Ethiopia remain limited. This study aimed to assess the survival status and predictors of mortality among preterm neonates admitted to the neonatal intensive care units of public hospitals in Central Ethiopia. A facility-based prospective cohort study was conducted among 347 preterm neonates admitted to the neonatal intensive care units in selected public hospitals from October 1, 2022, to June 28, 2023. All admitted preterm neonates were enrolled. Data were collected using a structured questionnaire. The Kaplan-Meier curve was used to estimate the mean survival time and cumulative survival probability. To declare the associations, the Cox proportional hazards model was used to identify mortality predictors with adjusted hazard ratios with 95% confidence interval (CI) and p value. Of 347 preterm newborns, 104 (29.97%) died, resulting in an incidence rate of 39.88 (95% CI: 32.90-48.33) fatalities per 1000 person-day observations. Born from mothers with chorioamnionitis (AHR 3.89; 95% CI: 2.44, 6.18), born from mothers with gestational diabetes mellitus (GDM) (AHR 2.01; 95% CI: 1.27, 3.17), Apgar score at fifth minute less than 7 (AHR 1.87; 95% CI: 1.04, 3.36), having respiratory distress syndrome (RDS) (AHR 2.03; 95% CI: 1.14, 3.61), receiving kangaroo mother care (KMC) (AHR 1.86; 95% CI: 1.18, 2.94), and born less than 32 weeks of gestation (AHR 2.52; 95% CI: 1.27, 3.17) were significant predictors of mortality. Around one-third of preterm neonates died. Improving the survival status should emphasize high-risk neonates, with low fifth-minute Apgar scores, having RDS, not receiving KMC, and neonates born to mothers with chorioamnionitis or GDM.