3 Mode of Delivery and Perinatal Outcomes in Premature Infants with Neurodevelopmental Risk Factors in Croatia in 2018

Abstract

<h3></h3> Investigate the association between mode of delivery and perinatal outcomes in premature infants with neurodevelopmental risk factors. Using Croatian Institute of Public Health childbirth database records, outcomes of preterm infants born in 2018 and diagnosed with pathological conditions associated with neurodevelopmental risk were analysed with regard to mode of delivery (vaginal, caesarean section – CS). Common pathologic findings/conditions associated with neurodevelopmental risk included: 5-minute Apgar score below 7, intrapartal hypoxia or asphyxia, intracranial haemorrhage (grade 3 or 4) and pulmonary pathology (respiratory distress, pulmonary haemorrhage, pneumothorax, other respiratory disorders). In some premature infants, multiple neurodevelopmental risk factors were reported. Other causes of morbidity were included in a common subgroup – Other entities. Data on early neonatal death (END) of premature infants caused by aforementioned conditions were also analysed. In 2018, 2,232 premature infants were born in Croatia (6% of all live-births). Pathological conditions were reported in 1,926 (86.2%) preterm infants, whereof 430 (19.3%) were primarily diagnosed with entities related to neurodevelopmental risk. 5-minute Apgar score below 7 was observed in 176 (7.9%) children, whereof 68.2% were delivered by CS and 31.8% vaginally. Hypoxia or asphyxia were the primary diagnosis in 33 (1.5%) and a secondary diagnosis in 107 (4.8%) children (140 in total – 6.3%); 58.6% were delivered by CS and 41.4% vaginally. Intracranial haemorrhage (grade 3 or 4) was the primary diagnosis in 19 (0.9%) children and a secondary diagnosis in 102 (4.6%), a total of 121 (5.4%); 92.5% were delivered by CS and 7.5% vaginally. Pulmonary disorders were the primary diagnosis in 378 (16.9%) children and a secondary diagnosis in 424 (19.0%) – a total of 802 (35.9%); 55.7% were born by CS and 44.3% vaginally. Other conditions were the primary cause of morbidity in 1,496 children (66.8%), whereof 50.5% were delivered by CS and 49.5% vaginally. Among 306 (13.7%) children recorded without any pathological condition, 41.5% were born by CS and 58.5% vaginally. Among 78 END cases, conditions related to neurodevelopmental risk (pulmonary pathology, intracranial haemorrhage) were the cause of death in 15 (19.2%); however, in additional 44 (56.4%) cases causes of death were indirectly associated with neurodevelopmental risk, except 19 (24.4%) deaths caused by congenital malformations. In preterm infants without neurodevelopmental risk factors, the incidence of CS and vaginal delivery were similar. Premature infants with conditions related to neurodevelopmental risk were more frequently delivered by CS as a means to prevent neurological and other impairments and perinatal death.