Twenty-five-year trends in mortality and major morbidity among very low birth weight infants at a Saudi tertiary centre: improving morbidity despite expanding resuscitation at the limits of viability.

Background: Very low birth weight (VLBW) infants remain at high risk of mortality and major morbidity, yet longitudinal data from Saudi Arabia spanning several decades are scarce. We examined 25-year trends in survival and morbidity at a single tertiary centre, with particular attention to whether patterns reflect evolving case-mix at the limits of viability. Methods: This retrospective cohort study included inborn VLBW infants (birth weight <1,500 g, gestational age <33 weeks) admitted to the NICU of King Saud University Medical City, Riyadh, across three periods: 1999-2007 ( Results: Crude survival declined significantly across periods (88.7%, 84.0%, 79.0%; Conclusion: Expanding active resuscitation at 22-24 weeks generated an apparent decline in crude survival, while care quality markedly improved, evidenced by large reductions in sepsis, necrotising enterocolitis, and severe retinopathy. Caution is warranted in attributing the decline in crude survival solely to the change in resuscitation policy at 22-24 weeks, as evolving clinical management strategies and other policy changes over the study period may also have contributed to the observed outcomes. Standardised national benchmarking and multicentre surveillance are needed.