Twenty-five-year trends in mortality and major morbidity among very low birth weight infants at a Saudi tertiary centre: improving morbidity despite expanding resuscitation at the limits of viability - Summary - MDSpire
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Twenty-five-year trends in mortality and major morbidity among very low birth weight infants at a Saudi tertiary centre: improving morbidity despite expanding resuscitation at the limits of viability
To examine 25-year trends in survival and morbidity of very low birth weight (VLBW) infants at a single tertiary center in Saudi Arabia.
Approach:
Study Design: Retrospective cohort study of inborn VLBW infants admitted to the NICU across three periods: 1999–2007, 2011–2018, and 2019–2024.
Inclusion Criteria: Infants with birth weight <1,500 g and gestational age <33 weeks; exclusions included those <22 weeks’ gestation or with lethal congenital anomalies.
Outcomes Measured: Primary outcome was survival to hospital discharge; secondary outcomes included various morbidity indicators such as respiratory distress syndrome and sepsis.
Statistical Analysis: Categorical variables compared using chi-square or Fisher's exact tests; continuous variables with ANOVA or Kruskal–Wallis tests.
Key Findings:
Crude survival rates declined significantly across periods: 88.7% (1999-2007, p = 0.001), 84.0% (2011-2018, p = 0.001), 79.0% (2019-2024, p = 0.001).
Among infants ≥24 weeks, survival rates were 90.0% (1999-2007, p = 0.001), 85.8% (2011-2018, p = 0.001), and 83.6% (2019-2024, p = 0.001), indicating the decline is driven by increased admissions at 22–24 weeks.
Substantial reductions in morbidity: early-onset sepsis from 11.0% to 2.3% (p < 0.001), late-onset sepsis from 37.2% to 17.2% (p < 0.001), necrotising enterocolitis from 15.6% to 9.3% (p < 0.001), and severe retinopathy from 34.5% to 6.3% (p < 0.001).
Respiratory distress syndrome prevalence rose to 99.5%; pneumothorax increased from 5.0% to 10.4% (p < 0.001); periventricular leukomalacia increased from 1.3% to 6.6% (p < 0.001).
Interpretation:
The decline in crude survival is largely attributed to the increased admission of infants at the limits of viability, while significant improvements in care quality are evidenced by reductions in major morbidities.
Limitations:
Multivariable regression analysis was not feasible due to aggregate historical data, limiting the ability to control for confounding variables.
Caution is warranted in attributing survival trends solely to changes in resuscitation policy.
Conclusion:
Expanding active resuscitation at 22–24 weeks has led to an apparent decline in crude survival, but care quality has markedly improved.
