Women with high-risk pregnancies require careful follow-up, management, and efficient allocation of resources to achieve optimal pregnancy outcomes. This study investigated the association between an updated, validated antenatal risk index score and neonatal mortality and morbidity in a tertiary care center in Saudi Arabia. This retrospective cohort study included pregnant women delivered at King Abdulaziz Medical City, Jeddah, Saudi Arabia, between June 2016 and December 2018. Pregnant women who delivered before arrival, delivered in another hospital, or without an antenatal risk score because of missing data were excluded. The study cohort was recruited by simple random selection. Data of mothers and neonates were extracted from electronic health records. The pregnancy risk was assigned using a validated antenatal risk score index, creating low, moderate, and high-risk pregnancy categories. The association between antenatal risk scores, maternal and neonatal outcomes was investigated. A total of 533 pregnant women were included in the analysis, of whom 298 (55.9%) had low antenatal risk scores, 185 (34.7%) had moderate-risk scores, and 50 (9.4%) had high-risk scores. Maternal characteristics showed that high-risk mothers had higher age, gravidity, parity, and abortions than those with low or moderate-risk pregnancies. Newborns of high-risk mothers belonged more often to the male gender and had lower gestational ages, birth weights, and Apgar scores. For maternal outcomes, there was no maternal mortality. High-risk mothers had more cesarean sections and longer lengths of stay as compared to the low and moderate risk group. There was a trend toward increased stillbirths. Neonatal mortality, neonatal intensive care unit (NICU) admission, congenital anomalies, and length of stay were significantly increased in neonates of high-risk mothers. An antenatal risk score is a feasible tool in identifying low, moderate, and high-risk pregnancies in a tertiary center outside a North American system. The higher scores were associated with maternal complications as well as neonatal mortality and morbidity. This is the first study to report maternal demographics, mortality, stillbirths, male gender, and congenital anomalies and their associations with categories of pregnancy level of risk. The clinical and economic benefits of antenatal risk screening in Saudi Arabia warrant further large population-based study that includes multi-domain socioeconomic determinants of health specific to our region.

Bronchiolitis is a leading cause of hospitalization worldwide for children aged ≤2 years. Few studies have compared general ward and pediatric intensive care unit (PICU) admissions, particularly in Saudi Arabia. This retrospective cohort study aimed to compare the demographic and clinical characteristics of children with bronchiolitis admitted to the general ward with those admitted to the PICU. Children (≤6 years) previously diagnosed with bronchiolitis and admitted to the PICU or general ward at a tertiary center in Saudi Arabia between May 2016 and May 2021 were included. Multiplex polymerase chain reaction was used to identify respiratory viruses. Of the 417 patients enrolled, 67 (16.06%) were admitted to the PICU. The PICU group was younger (median, 2 months; interquartile range [IQR], 1–5 months) vs. (6 months; IQR, 2.65–13.25 months). There was a dramatic reduction in bronchiolitis admissions during the COVID-19 pandemic. The most common causative virus was respiratory syncytial virus (RSV) (54.9%). In the multivariate regression analysis, hypoxia, hyperinflation on X-ray, and non-RSV bronchiolitis were independently associated with PICU admission. However, a higher chronological age and cough were protective. Children with Down syndrome, immunodeficiency, or neuromuscular disorders, and intermediate preterm infants (29–33 weeks of gestation) are at a high risk of PICU admission (adjusted odds ratio: 2.4, 7.1, 2.9, and 2.9; p = 0.037, 0.046, 0.033, and 0.029, respectively). Bronchiolitis is still one of the leading causes of PICU admission. Particular attention should be paid to preventive measures, especially in the post-COVID-19 era, targeting high-risk groups.

Respiratory syncytial virus (RSV) is the major cause of bronchiolitis among children under 5 years of age worldwide, accounting for a prevalence of 25%–88% in Saudi Arabia. Although no effective treatment for the virus exists, passive immunoprophylaxis reduced RSV hospitalizations in high-risk children. With recent advances in immunization, the Saudi Initiative of Bronchiolitis Diagnosis, Management, and Prevention panel screened recent relevant international guidelines, locally published data, and expert consensus to update guidelines for RSV prevention, taking into consideration the resources, timing, varying health profiles, and RSV burden in Saudi Arabia. The panel updated its recommendations to include immunization of infants, mothers, and older adults. Practical guidelines were prepared to facilitate the administration of the short-acting and newly developed long-acting RSV monoclonal antibodies (mAb) during the regular follow-ups of high-risk infants in specialized clinics. In addition, long-acting mAb was highlighted as all-infant protection in the routine immunization calendar.

Preterm infants are more susceptible to death, short-term complications, and long-term complications such as neurodevelopmental impairments. However, definitive assessment tools are not available in a resource-limited setting. Hence a screening tool is needed the Arabic-speaking population. Infants born at a gestational age of <32 weeks or a very low birth weight (VLBW) of less than 1500 g were recruited into a cross-sectional study. We identified infants (n = 61) admitted to the neonatal ICU at King Abdulaziz Medical City and reached 18 up to 24 months of corrected gestational age (CGA). The developmental assessment was done at 18, 20, 22, and 24 CGAs using the Ages and Stages Questionnaire third edition - Arabic version (ASQ3-A). The primary outcomes are early detection rate of neurodevelopmental delay (NDD), defined as a delay in one or more of the following: communication, gross motor, fine motor, problem-solving, and personal-social skills as per ASQ3-A. Sixty-one out of 92 eligible infants (36 excluded) completed the sufficient assessment. Twenty-six infants (42.6%) had at least one NDD in one of the following domains: communication skills: (11.5%), gross motor: (11.5%), fine motor: (19.7%), problem-solving skills: twelve infants (19.7%), and personal-social skills: twenty infants (23%). Perinatal events and periventricular leukomalacia (PVL) were significant independent predictors for the NDD. This single-center study in Saudi Arabia screened preterm, VLBW infants based on ASQ3-A, twenty infants (42.6%) had an abnormal NDD at a corrected age of 18-24 months. Perinatal events and PVL were independent predictors of NDD. We recommend that all preterm VLBW infants in Saudi Arabia be evaluated by a neurodevelopmental screening tool, ASQ3-A, especially in resource-limited settings to start early intervention. Also, more extensive multicenter studies are to be carried out with definitive diagnostic tools to have a national benchmark for the long-term neurodevelopmental impairment.

Objectives Socioeconomic status (SES) plays a conflicting role in preterm birth (PB). This study evaluated the association between SES and PB using, for the first time, a multidomain scale, validated for Saudi Arabia, with a scoring system and examined the effect of each SES domain on PB. The secondary outcome was to determine the effects of SES on birth weight (BW) and the subcategories of PB and BW. Methods This cross-sectional study was conducted between May 2017 and August 2017 at a National Guard tertiary center in Jeddah, Saudi Arabia. A total of 477 parents were interviewed using the Elzahrany R. SES scale. Results The rate of PB was 11.5%, with no significant differences among the high, middle, and low SES classes (13%, 11%, and 12.5%, respectively). There were no patients in the very low SES in this specific population. None of the maternal or neonatal characteristics were significantly different among SES classes except maternal age (p value = 0.03), and antenatal care recorded visits "booking" status (p value = 0.012). Stratified analysis for PB subcategories showed the lower SES classes had higher moderate (3.8%) and extreme (1.6%) PB. For BW subcategories, large for gestational age (LGA) infants were higher in the high SES class (13%). However, the lower SES classes had higher rates of lower BW. The association between SES and PB remained not significant after adjusting for the maternal age and antenatal booking status. Conclusion There was no association between SES and PB at a tertiary center providing universal care to the National Guard using multidomain socioeconomic determinants with a scoring system. However, lower SES was associated with lower BW. The use of the "polysocial risk score" based on locally validated surveys should be considered in any health research that examines the effects of socioeconomic determinants.

In Saudi Arabia and countries around the world, clinical health practice has been transformed by the coronavirus 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). During the early days of the pandemic, it was a major challenge to care for pregnant women with laboratory-confirmed COVID-19 and their newborn infants. In this article, we share our experience in the management of newborn infants delivered to mothers with laboratory-confirmed COVID-19. A prospective single-center observational study was conducted at King Abdulaziz Medical City in Jeddah, National Guard Health Affairs, Saudi Arabia. Data collection started in March 2020 and was completed in October 2020. The inclusion criteria included mothers with laboratory-confirmed COVID-19 and their newborn infants. A total of 45 pregnant women with polymerase chain reaction (PCR)-confirmed COVID-19 were included in the study. Their mean age was 30.23±5.92 years. The mode of delivery was spontaneous vaginal delivery in 27 women (60%), cesarean section in 15 women (33.3%), and assisted vaginal delivery in three women (6.7%). Three mothers (6.7%) required intensive care unit admission. A total of 45 babies were born and 25 were females (55.6%), 20 males (44.4%). None of the babies had specific symptoms related to COVID-19. All babies were tested negative on the two COVID-19 nasopharyngeal swabs. Babies were initially admitted to the NICU and one baby required prolonged NICU stay due to extreme prematurity (23 weeks), one baby died due to hypoxic-ischemic encephalopathy and respiratory distress syndrome, and the remaining babies were discharged home in a stable condition. Our experience suggests that maternal outcomes are generally favorable and no difference between vaginal and cesarean delivery in the risk of virus transmission. With strict implementation of infection prevention measures, mother-to-infant transmission is very unlikely. Early bathing of the newborn infant is preferred to reduce the risk of transmission of infection to newborn infants and the hospital staff. Breastfeeding is safe if performed under strict infection prevention measures.