Mortality and Morbidity Pattern of Preterm Neonates: Findings of a Retrospective Study From Saudi Arabia

Objectives: To describe morbidity and mortality among preterm neonates (<37 weeks' gestation) admitted to the neonatal intensive care unit (NICU) at Johns Hopkins Aramco Healthcare (JHAH), to evaluate survival by gestational age (GA), and to identify factors associated with mortality.Methods: This single-center retrospective cohort study reviewed the electronic medical records of all preterm neonates born at JHAH, Dhahran, Saudi Arabia, and admitted to the NICU between January 2019 and December 2023.Maternal, perinatal, and neonatal variables were compared between survivors and nonsurvivors.Survival to discharge by GA was compared using the log-rank test, and factors associated with mortality were assessed using Firth penalized logistic regression.Results: Of 587 neonates, 22 (3.7%) died before discharge.Survival was 63.4% at 22-27 weeks, 95.2% at 28-31 weeks, and 99.4% at 32-36 weeks (p < 0.001).The most common complications were bronchopulmonary dysplasia (12.8%), patent ductus arteriosus (9.7%), and intraventricular hemorrhage (3.4%), all more frequent among non-survivors.After adjustment, higher GA was associated with lower mortality (28-31 weeks: adjusted odds ratio (aOR): 0.11, 95% CI: 0.03-0.33;32-36 weeks: aOR: 0.015, 95% CI: 0.003-0.046),and small-for-gestational-age status with higher mortality (aOR: 3.82, 95% CI: 1.11-12.61).Conclusion: Mortality among preterm neonates was low overall but concentrated among those born before 28 weeks.GA was the strongest predictor of survival, and growth restriction independently increased mortality risk.