Trends in Survival and Short-Term Outcomes Among Preterm Infants Less Than 32 Weeks From 2016 to 2022: A Retrospective Cohort Study at a Tertiary Medical Center in the UAE

TL;DR

The study shows improved survival rates for preterm infants under 32 weeks in the UAE from 2016 to 2022, but with increased complications like BPD and sepsis.

Contribution

This study provides updated survival and complication trends for preterm infants in the UAE, highlighting changes in outcomes over a seven-year period.

Findings

Survival rates increased from 23.8% in 2016-2019 to 17.6% in 2020-2022.

There was a significant rise in bronchopulmonary dysplasia (BPD) and periventricular leukomalacia (PVL) among survivors.

Late-onset sepsis increased significantly between the two study periods.

Abstract

Introduction

Contemporary data on preterm infant outcomes are vital for improving healthcare resources and results, as well as guiding professionals and families in counselling and decision-making.

Objective

To examine the survival rates, in-hospital complications, and antenatal care practices for infants born before 32 weeks of gestational age.

Methods

Demographics and outcome data were retrospectively gathered, adhering to standard definitions, for a cohort of infants born before 32 weeks of gestational age admitted between January 2016 and December 2022 at Tawam Hospital, UAE.

Results

Of the 700 infants with gestational ages 22+0 to 31+6, over the seven years, 553 (79%) survived to discharge. Overall, the median (IQR) length of stay in survivors was 67 (42, 95) days. Bronchopulmonary dysplasia (BPD) (any grade) was 228 (40.5%), and 89 (12.9%) preterm infants had necrotizing enterocolitis (NEC) stage 2 and above. Late-onset sepsis was seen in 195 (30.1%) cases. Regarding neurological injury, intraventricular hemorrhage (IVH) grade 3 and above was recorded in 57 (9.2%) cases, and periventricular leukomalacia (PVL) was noted in 37 (8.4%) infants. Patent ductus arteriosus (PDA) treatment was given to 115 (16.7%), and retinopathy of prematurity (ROP) treatment was needed in 8.5% of preterm infants.

The study was divided into two periods: period 1 (2016-2019) and period 2 (2020-2022). Mortality was 92 (23.8%) in period 1 vs. 55 (17.6%) in period 2. Morbidities between period 1 vs. period 2 were as follows: BPD 101 (33.8%) vs. 127 (48.1%) (p < 0.0001), PVL 13 (5.7%) vs. 24 (11.2%) (p < 0.038), and sepsis 90 (25.5%) vs. 105 (35.6%) (p = 0.005). Rates of ROP needing treatment and NEC≥2, 18 (7.1%) vs. 23 (10%) and 45 (11.8%) vs. 44 (14.3%), respectively, p=0.239 and p=0.327, respectively, and severe IVH 34 (10%) vs. 23 (8%) (p=0.357).

Conclusion

A significant increase in survival in less than 32 weeks was noted over the study period. Increase in survival was associated with a notable rise in BPD, PVL, and sepsis. Rates of ROP needing treatment and NEC ≥ 2 increased, but the rise didn’t reach statistical significance. On the other hand, a non-statistically significant reduction in severe IVH cases was observed.

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