Al-Hindi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

BACKGROUND: Newborn infants with birth weight less than 1500 grams defining very low birth weight (VLBW) constitute 1.2–1.5% of total live births and 15–20% of all admissions to neonatal units. Advances in antenatal care, care at delivery, and neonatal practice over the past few decades, have substantially improved outcomes in VLBW infants, and reduced neonatal mortality. METHODS: A retrospective single tertiary care center cohort study of VLBW infants with gestational age between 23–33 weeks admitted to the neonatal intensive care unit (NICU) in King Abdulaziz Medical City, Jeddah (KAMC-J) between January 1, 1994, and December 31, 2019 (26 years). The trends of survival of VLBW infants and major changes in clinical practice of premature care over a period of 26 years were evaluated. RESULTS: Over a period of 26 years, 1,247 VLBW infants were admitted to the NICU that represents 1.43% (1.25–1.83%) of total live births. 50.80% (n = 634) were male, whereas the 49.2% (n = 613) were female. Among them, 1013 (81.2%) were discharged home alive. There was a significant and progressive improvement in the survival rate of VLBW infants over a 26-year period from 66.83% in period 1 (1994 –1998) to 90.0 % in period 5 (2014 –2019), which represents a 34.67% total improvement rate. The improvement in survival rates was observed in all gestational ages between 23–33 weeks, particularly in infants weighing ≤750 grams and ≤1000 grams, and with gestational age between 23–27 weeks. Infants with a gestational age of ≤26 weeks and birth weight ≤750 grams delivered by cesarean section had a higher survival rate. Moreover, female infants with a gestational age of ≤26 weeks and birth weight ≤750 grams had a higher survival rate compared to males but not statistically significant. CONCLUSIONS: The survival rate of VLBW infants had improved significantly over the past 26 years (1994 –2019). This is attributed mainly to the improved survival of ELBW infants (<1000 grams) and gestational age of ≤26 weeks.