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Research ArticleOriginal Article
Open Access

A cross-sectional analysis of preterm birth incidence and survival in Al Kharj, Saudi Arabia

Mshari Alghadier, Muneera Alasraj, Ragab Elnaggar, Mashael Alazmi, Asma Aldawsari, Saud Alnadah, Faisal Alqahtani and Donia Zaghamir
Saudi Medical Journal July 2024, 45 (7) 710-718; DOI: https://doi.org/10.15537/smj.2024.45.7.20240194
Mshari Alghadier
From the Department of Health & Rehabilitation Sciences (Alghadier, Alasraj, Elnaggar), Prince Sattam bin Abdulaziz University; from the Department of Maternal & Child Health Nursing (Zaghamir), College of Nursing, Prince Sattam Bin Abdulaziz University; from the Department of Physical Therapy (Alazmi), from the Department of Quality (Aldawsari), from the Department of Hospital Administration (Alnadah), and from the Department of Pediatrics (Alqahtani), Maternity and Children’s Hospital, Al Kharj, Kingdom of Saudi Arabia; from the Department of Physical Therapy for Pediatrics (Elnaggar), Faculty of Physical Therapy, Cairo University, Giza; and from the Department of Pediatric Nursing (Zaghamir), Faculty of Nursing, Port Said University, Egypt.
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Muneera Alasraj
From the Department of Health & Rehabilitation Sciences (Alghadier, Alasraj, Elnaggar), Prince Sattam bin Abdulaziz University; from the Department of Maternal & Child Health Nursing (Zaghamir), College of Nursing, Prince Sattam Bin Abdulaziz University; from the Department of Physical Therapy (Alazmi), from the Department of Quality (Aldawsari), from the Department of Hospital Administration (Alnadah), and from the Department of Pediatrics (Alqahtani), Maternity and Children’s Hospital, Al Kharj, Kingdom of Saudi Arabia; from the Department of Physical Therapy for Pediatrics (Elnaggar), Faculty of Physical Therapy, Cairo University, Giza; and from the Department of Pediatric Nursing (Zaghamir), Faculty of Nursing, Port Said University, Egypt.
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Ragab Elnaggar
From the Department of Health & Rehabilitation Sciences (Alghadier, Alasraj, Elnaggar), Prince Sattam bin Abdulaziz University; from the Department of Maternal & Child Health Nursing (Zaghamir), College of Nursing, Prince Sattam Bin Abdulaziz University; from the Department of Physical Therapy (Alazmi), from the Department of Quality (Aldawsari), from the Department of Hospital Administration (Alnadah), and from the Department of Pediatrics (Alqahtani), Maternity and Children’s Hospital, Al Kharj, Kingdom of Saudi Arabia; from the Department of Physical Therapy for Pediatrics (Elnaggar), Faculty of Physical Therapy, Cairo University, Giza; and from the Department of Pediatric Nursing (Zaghamir), Faculty of Nursing, Port Said University, Egypt.
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Mashael Alazmi
From the Department of Health & Rehabilitation Sciences (Alghadier, Alasraj, Elnaggar), Prince Sattam bin Abdulaziz University; from the Department of Maternal & Child Health Nursing (Zaghamir), College of Nursing, Prince Sattam Bin Abdulaziz University; from the Department of Physical Therapy (Alazmi), from the Department of Quality (Aldawsari), from the Department of Hospital Administration (Alnadah), and from the Department of Pediatrics (Alqahtani), Maternity and Children’s Hospital, Al Kharj, Kingdom of Saudi Arabia; from the Department of Physical Therapy for Pediatrics (Elnaggar), Faculty of Physical Therapy, Cairo University, Giza; and from the Department of Pediatric Nursing (Zaghamir), Faculty of Nursing, Port Said University, Egypt.
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Asma Aldawsari
From the Department of Health & Rehabilitation Sciences (Alghadier, Alasraj, Elnaggar), Prince Sattam bin Abdulaziz University; from the Department of Maternal & Child Health Nursing (Zaghamir), College of Nursing, Prince Sattam Bin Abdulaziz University; from the Department of Physical Therapy (Alazmi), from the Department of Quality (Aldawsari), from the Department of Hospital Administration (Alnadah), and from the Department of Pediatrics (Alqahtani), Maternity and Children’s Hospital, Al Kharj, Kingdom of Saudi Arabia; from the Department of Physical Therapy for Pediatrics (Elnaggar), Faculty of Physical Therapy, Cairo University, Giza; and from the Department of Pediatric Nursing (Zaghamir), Faculty of Nursing, Port Said University, Egypt.
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Saud Alnadah
From the Department of Health & Rehabilitation Sciences (Alghadier, Alasraj, Elnaggar), Prince Sattam bin Abdulaziz University; from the Department of Maternal & Child Health Nursing (Zaghamir), College of Nursing, Prince Sattam Bin Abdulaziz University; from the Department of Physical Therapy (Alazmi), from the Department of Quality (Aldawsari), from the Department of Hospital Administration (Alnadah), and from the Department of Pediatrics (Alqahtani), Maternity and Children’s Hospital, Al Kharj, Kingdom of Saudi Arabia; from the Department of Physical Therapy for Pediatrics (Elnaggar), Faculty of Physical Therapy, Cairo University, Giza; and from the Department of Pediatric Nursing (Zaghamir), Faculty of Nursing, Port Said University, Egypt.
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Faisal Alqahtani
From the Department of Health & Rehabilitation Sciences (Alghadier, Alasraj, Elnaggar), Prince Sattam bin Abdulaziz University; from the Department of Maternal & Child Health Nursing (Zaghamir), College of Nursing, Prince Sattam Bin Abdulaziz University; from the Department of Physical Therapy (Alazmi), from the Department of Quality (Aldawsari), from the Department of Hospital Administration (Alnadah), and from the Department of Pediatrics (Alqahtani), Maternity and Children’s Hospital, Al Kharj, Kingdom of Saudi Arabia; from the Department of Physical Therapy for Pediatrics (Elnaggar), Faculty of Physical Therapy, Cairo University, Giza; and from the Department of Pediatric Nursing (Zaghamir), Faculty of Nursing, Port Said University, Egypt.
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Donia Zaghamir
From the Department of Health & Rehabilitation Sciences (Alghadier, Alasraj, Elnaggar), Prince Sattam bin Abdulaziz University; from the Department of Maternal & Child Health Nursing (Zaghamir), College of Nursing, Prince Sattam Bin Abdulaziz University; from the Department of Physical Therapy (Alazmi), from the Department of Quality (Aldawsari), from the Department of Hospital Administration (Alnadah), and from the Department of Pediatrics (Alqahtani), Maternity and Children’s Hospital, Al Kharj, Kingdom of Saudi Arabia; from the Department of Physical Therapy for Pediatrics (Elnaggar), Faculty of Physical Therapy, Cairo University, Giza; and from the Department of Pediatric Nursing (Zaghamir), Faculty of Nursing, Port Said University, Egypt.
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Article Figures & Data

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    Figure 1

    - The number of total births and preterm births admitted to the Neonatal Intensive Care Unit (NICU) from 2018 to 2022.

Tables

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    Table 1

    - Characteristics of study population and neonatal outcomes.

    Characteristicsn (%)
    Gender
    Male74 (53.2)
    Female65 (46.8)
    Mother nationality
    Saudi97 (69.7)
    Non-Saudi42 (30.3)
    Mode of delivery
    Vaginal69 (49.6)
    Cesarean70 (53.2)
    Pregnancy identified
    US28 (20.1)
    LMP90 (64.7)
    Clinical examination17 (12.2)
    Mother’s weight at delivery, kg (mean±SD)74.2±17.4
    Mother’s height at delivery, cm (mean±SD)157.6±6
    Maternal age, years (mean±SD)29.2±7.25
    Average of antenatal visits (mean±SD)4.8±2.9
    History of abortions
    Yes32 (23.1)
    No107 (76.9)
    Plurality
    Singletons120 (86.3)
    Twins13 (9.3)
    Triples6 (4.3)
    Primipara39 (28.0)
    GA, weeks (mean±SD)32.9±3.9
    SGA62 (44.6)
    BW, grams1941±723
    Length of stay in NICU, days (mean±SD)18.2±21.4
    Weight at NICU discharge, g (mean±SD)2098±555
    Low APGAR (<7 at 5 minutes) (mean±SD)24±17.2
    According to GA
    Extremely preterm (<28 weeks)15 (10.79)
    Very preterm (28 to <32 weeks)27 (19.42)
    Late preterm (32 to <37 weeks)97 (69.78)
    According to BW (grams)
    Less than 1000 (ELBW)13 (9.35)
    1000 to 1499 (VLBW)25 (17.99)
    1500 to 2499 (LBW)74 (53.24)
    2500 to 3999 (NBW)27 (19.42)

    SD: standard deviation, US: ultrasound, LMP: last menstrual period, GA: gestational age, SGA: Small for gestational age, BW: birth weight, NICU: neonatal intensive care unit, ELBW: extremely low birth weight, VLBW: very low birth weight, LBW: low birth weight, NBW: normal birth weight

      • View popup
      Table 2

      - Mortality rate classified by GA and BW.

      ClassificationMortality rate n (%)
      According to GA (weeks)
      Extremely preterm (<28 weeks)6/15 (40)
      24 weeks gestation3/4 (75)
      25 weeks gestation1/2 (50)
      26 weeks gestation1/6 (16.6)
      27 weeks gestation1/3 (33.3)
      Very preterm (28 to <32 weeks)1/27 (3.7)
      Late preterm (32 to <37 weeks)3/97 (3)
      According to BW (grams)
      Less than 1000 (ELBW)5/13 (38.4)
      1000 to 1499 (VLBW)2/25 (8)
      1500 to 2499 (LBW)3/74 (4.05)
      2500 to 3999 (NBW)0/27 (0)

      GA: gestational age, BW: birth weight, ELBW: extremely low birth weight, VLBW: very low birth weight, LBW: low birth weight, NBW: normal birth weight

        • View popup
        Table 3

        - Percentage (%) of antepartum and intrapartum complications among the premature population presented by year.

        Condition20182019202020212022OverallP-value
        Antepartum conditions
        Gestational hypertension0.72.21.43.60.78.60.17
        Maternal hypertension00.702.20.73.60.11
        Maternal infection00.702.20.73.60.11
        Maternal malnutrition0.70.702.20.74.30.24
        Maternal diabetes0.70.71.72.10.75.90.14
        PROM7.97.94.37.25.833.10.12
        Fetal anomaly0.70.70.72.20.750.48
        Intrauterine infection00.702.20.73.60.11
        Placental complications0.71.41.42.92.28.60.60
        Cord complications00.702.20.73.60.11
        Intrapartum conditions
        Disproportion/dystocia00.702.202.90.03*
        Malpresentation2.93.61.42.94.315.10.74
        Prolonged labour00.702.202.90.03*
        Placental complications00.702.21.44.30.16
        Cord complications00.702.20.73.60.11

        Chi-square,

        • ↵* significant (p<0.05), PROM: prolonged rupture of membrane

        • View popup
        Table 4

        - Comparison of risk factors of the preterm infants based on GA.

        VariableExtremely preterm (n=15)Very preterm (n=27)Late preterm (n=97)P-value
        BW, grams993 ± 4491413 ± 3752234 ± 614<0.001*
        Age at delivery, years32.4 ± 5.427.5 ± 6.629.1 ± 7.50.119
        Weight at delivery, kg73. 1 ± 14.773.1 ± 14.174.6 ± 18.70.90
        APGAR score at 1 minute4.2 ± 2.35.2 ± 2.26.8 ± 2.1<0.001*
        APGAR score at 5 minutes6 ± 1.97.3 ± 1.98.4 ± 1.1<0.001*
        APGAR score at 10 minutes7.3 ± 2.18.4 ± 1.49.1 ± 0.9<0.001*
        Length of stay in NICU40.2 ± 34.332.8 ± 16.310.7 ± 14.9<0.001*
        PROM0.26 ± 0.450.25 ± 0.440.36 ± 0.480.52
        Malpresentation0.13 ± 0.350.14 ± 0.320.15 ± 0.360.97

        One-way ANOVA;

        BW: birth weight; PROM: prolonged rupture of membrane, NICU: neonatal intensive care unit

        • ↵* significant (p<0.05).

        • View popup
        Table 5

        - Percentage of common neonatal morbidities among preterm infants.

        Neonatal MorbidityPercentage (%)
        Respiratory distress syndrome (RDS)27.3
        Bronchopulmonary dysplasia (BPD)15.8
        Patent ductus arteriosus (PDA)12.5
        Retinopathy of prematurity (ROP)10.2
        Intraventricular hemorrhage (IVH)8.9
        Necrotizing enterocolitis (NEC)5.6
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      A cross-sectional analysis of preterm birth incidence and survival in Al Kharj, Saudi Arabia
      Mshari Alghadier, Muneera Alasraj, Ragab Elnaggar, Mashael Alazmi, Asma Aldawsari, Saud Alnadah, Faisal Alqahtani, Donia Zaghamir
      Saudi Medical Journal Jul 2024, 45 (7) 710-718; DOI: 10.15537/smj.2024.45.7.20240194

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      A cross-sectional analysis of preterm birth incidence and survival in Al Kharj, Saudi Arabia
      Mshari Alghadier, Muneera Alasraj, Ragab Elnaggar, Mashael Alazmi, Asma Aldawsari, Saud Alnadah, Faisal Alqahtani, Donia Zaghamir
      Saudi Medical Journal Jul 2024, 45 (7) 710-718; DOI: 10.15537/smj.2024.45.7.20240194
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