Abstract
BACKGROUND: Neural tube defects (NTDs) remain a leading cause of neonatal morbidity and mortality worldwide, with persistently high prevalence in low- and middle-income countries including Turkey. Despite advances in prenatal screening and neurosurgical care, survival outcomes remain variable. This study aimed to assess national trends in survival duration, surgical intervention patterns, and regional disparities in neonatal NTD outcomes across Turkey over a 7-year period. MATERIAL AND METHODS: We conducted a nationwide retrospective cohort study of 7,606 liveborn neonates diagnosed with NTDs between 2015 and 2021. Data were extracted from hospital-based registries and included clinical, demographic, and regional variables. Primary outcomes were survival duration and rate of surgical intervention. Linear regression was used to assess temporal survival trends, and Kaplan-Meier analysis compared survival between surgical and non-surgical groups. RESULTS: The mean survival duration declined markedly from 705.2 days in 2015 to 123.0 days in 2021 (p < 0.001), with linear regression revealing a significant annual decrease of 82.2 days (R(2) = 0.91). Surgical intervention was performed in 30.3% of cases overall, with notable regional variability. Kaplan-Meier survival analysis demonstrated significantly longer survival among neonates who underwent surgery (mean: 450.6 days) compared to those who did not (mean: 290.2 days; p < 0.0001). The Black Sea region exhibited the highest average survival despite low intervention rates, whereas Southeastern Anatolia had the highest surgery rate but the lowest survival duration. CONCLUSIONS: Despite incremental improvements in surgical access, neonatal survival among infants with NTDs in Turkey has declined over the past decade. Marked regional inequities and the limited effect of surgery on overall survival underscore the need for comprehensive strategies addressing prevention, early diagnosis, timely surgical care, and equitable neonatal intensive care delivery.