Dynamics of Preterm Birth and Intensive Care Admission Rates Before and During COVID-19 Pandemic: A Comparative Observational Study

Objective: To compare preterm birth and neonatal intensive care unit admission rates before and during the coronavirus disease-2019 (COVID-19) pandemic in a tertiary care center, and to examine whether pandemic-related restriction phases and selected sociodemographic characteristics were associated with changes in neonatal outcomes.Method: This retrospective, cross-sectional study was conducted at a tertiary care hospital in İzmir, Türkiye.Medical records of 813 newborns delivered between September 11, 2018 and September 11, 2021 were reviewed.Pre-pandemic (n=401) and pandemic (n=412) cohorts were defined.Maternal and neonatal clinical variables were analyzed.Primary outcomes were preterm births (delivery before 37 weeks of gestation) and neonatal intensive care (NICU) admissions; secondary outcome analyses evaluated indications for NICU care.Non-parametric and chi-square tests were used, with the level of statistical significance set at p<0.05.Results: The overall preterm birth rate was 28.2%, with similar rates in the pre-pandemic (28.7%) and pandemic (27.7%) groups (p=0.732).The NICU admission rate was 30.3%, rising from 27.7% in the prepandemic period to 32.8% during the pandemic period (p=0.114).Transient tachypnea of the newborn and respiratory distress syndrome were the most common NICU diagnoses.In the pre-pandemic period, preterm birth was more frequent among Syrian newborns (p=0.021), and first-minute Apgar scores of preterm infants were lower (p=0.002).Preterm birth and NICU admission rates did not differ between lockdown and normalization phases (all p>0.05).Conclusion: Preterm birth rates were similar before and during the COVID-19 pandemic.NICU admission rates showed a non-significant absolute increase of approximately 5 percentage points during the pandemic, but the available sample size was not sufficiently powered to exclude a clinically relevant difference.The higher proportion of preterm Syrian infants in the pre-pandemic period suggests that social and healthcare-access factors may be important when interpreting pandemic-related neonatal outcomes.These findings should be considered hypothesis-generating and require confirmation in larger multicenter cohorts.