# 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.

## Key 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.