Survival status and predictors of mortality in extreme preterm babies: A decade of experience at a tertiary care centre in Sri Lanka

Introduction: Preterm birth and complications are the leading cause of death globally in under-five children. In Sri Lanka, in the absence of a preterm birth database, there is a lack of information about survival and risk factors for mortality in the extreme preterm populations.
Objectives: To assess the predictors of mortality in extreme preterm babies.
Method: This was a 10-year retrospective analysis of all live births at 22+0 to 27+6 weeks’ gestation in a single centre in Sri Lanka. Records of all extreme preterm babies admitted from 1st January 2013 and 31st December 2022 were reviewed. Survival probability was calculated using Kaplan-Meier estimates. Multivariable cox regression analysis was done to assess the predictors of mortality.
Results: Of the 123 records reviewed 55.3% survived. Mean survival time was 64.7 (95% CI: 55.57, 73.86) days. Approximately a quarter of deaths occurred on the first day of life.  Period of gestation (OR:0.60, CI: 0.482, 0.739, p<0.001), weight for gestational age (OR: 2.57, CI: 1.476, 4.468, p=0.001) and sepsis (OR: 6.45, CI: 2.006, 20.749, p=0.002) were significantly associated with mortality.
Conclusions: In our study 55.3% of extreme preterm babies survived. The mortality decreased with increasing gestational age whilst it increased with sepsis and the presence of small for gestational age.