{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:38:14Z","timestamp":1792791494028,"version":"4.5.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study included inborn VLBW infants (birth weight &amp;lt;1,500\u2005g, gestational age &amp;lt;33 weeks) admitted to the NICU of King Saud University Medical City, Riyadh, across three periods: 1999\u20132007 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009468), 2011\u20132018 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009512), and 2019\u20132024 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009396). Infants &amp;lt;22 weeks\u2019 gestation or with lethal congenital anomalies were excluded. The primary outcome was survival to hospital discharge. Secondary outcomes were respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, intraventricular haemorrhage, periventricular leukomalacia, necrotising enterocolitis, retinopathy of prematurity, and culture-proven sepsis. Categorical variables were compared using chi-square or Fisher's exact tests, continuous variables with ANOVA or Kruskal\u2013Wallis tests. Multivariable regression was precluded by aggregate historical data; a sensitivity analysis restricted to infants \u226524 weeks examined case-mix effects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Crude survival declined significantly across periods (88.7%, 84.0%, 79.0%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). However, among infants \u226524 weeks, survival was 90.0%, 85.8%, and 83.6%, indicating the overall decline is largely driven by increasingly admitted infants at 22\u201324 weeks. Survival at 23 weeks fell from 61.0% to 6.3%, while survival at 27\u201331 weeks remained above 80% without significant change. Morbidity improvements were substantial: early-onset sepsis fell from 11.0% to 2.3%, late-onset sepsis from 37.2% to 17.2%, necrotising enterocolitis from 15.6% to 9.3%, and severe retinopathy requiring treatment from 34.5% to 6.3% (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Respiratory distress syndrome prevalence rose to 99.5%, while surfactant and postnatal corticosteroid use declined. Pneumothorax increased from 5.0% to 10.4% and periventricular leukomalacia from 1.3% to 6.6%; severe intraventricular haemorrhage remained unchanged.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Expanding active resuscitation at 22\u201324 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\u201324 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1881490","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T05:36:40Z","timestamp":1783575400000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["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"],"prefix":"10.3389","volume":"14","author":[{"given":"Lana A.","family":"Shaiba","sequence":"first","affiliation":[{"name":"Department of Pediatrics, College of Medicine, King Saud University","place":["Riyadh, Saudi Arabia"]},{"name":"Neonatology, King Saud University Medical City","place":["Riyadh, Saudi 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