Objectives: This study aimed to evaluate trends in morbidity, mortality, risk factors, complications and clinical practices among preterm infants admitted to a neonatal intensive care unit (NICU) and to explore whether optimisation of neonatal care can contribute to broader national health and prosperity. Material and Methods: A nested case–control study was carried out in a tertiary NICU in Saudi Arabia. Preterm infants born <37 weeks were included. Infants who died within 1 year were designated as cases and those who survived with morbidities as controls. Key variables included gestational age (GA), birth weight (BW), gender, Apgar scores and maternal antenatal steroid exposure. Statistical comparisons were made between two groups for qualitative and quantitative variables using Chi-square, odds ratio and interquartile range and were validated using the Mann–Whitney U-test. A confidence interval of 95% and P < 0.05 were considered statistically significant. Results: A total of 49 preterm infants were analysed (15 cases, 34 controls). The case group had significantly lower GA and BW compared with the control group (Mann–Whitney U P < 0.001). Antenatal steroid use and Apgar scores were significantly lower among case group compared to the control group. The incidence of seizure and grade 4 intraventricular haemorrhage (IVH) were higher in the case group ( P = 0.05). The occurrence of other neonatal morbidities – including patent ductus arteriosus (PDA), necrotising enterocolitis (NEC), bronchopulmonary dysplasia and retinopathy of prematurity, sepsis did not show a statistically significant difference between the groups. However, severe form of these complications such as grade 4 IVH, severe NEC, large PDA and severe sepsis, was predominantly noted among the case group compared to the control. Conclusion: Mortality among preterm infants is markedly noted with lower GA (<27 weeks), low BW (<970 g) and absence of antenatal steroid exposure to the mother. Severe NEC, moderate-to-large PDA, sepsis, seizures and grade 4 IVH were significantly observed risk factors increasing the risk of mortality. Although NICU care has improved the survival of preterm babies, morbidities among survivors remain substantial. Enhancing antenatal care, midwife-led antenatal care as a bridge between obstetrician and mother, advanced neonatal management and post-discharge follow-up in liaison with multidisciplinary team may reduce preterm birth and its related complications and may potentially improve long-term health outcome, reduce healthcare and social cost and enhance national wellbeing and economic prosperity.
Hirensinh Jitendrasinh Rao (Thu,) studied this question.