385 Head injuries related to birth trauma during vacuum extraction in low birth-weight neonates

Abstract

To evaluate the impact of vacuum extraction on neonatal head injuries related to birth trauma, among new-borns with low birth weight (BW) (<2,500 g) using a non-metal vacuum cup. Retrospective cohort study of 3335 women with a singleton pregnancy, ≥34 gestational weeks delivered by a vacuum extraction, between 2014 and 2019. The current study compared head injuries related to birth trauma, and rates of other neonatal complications of 207 (6.2%) neonates with a BW < 2,500 g to 3128 (93.8%) neonates with higher BW, divided into three subgroups (2,500-2,999g, 3,000-3,499g, ≥3,500g) The lowest rates of subgaleal hematomas occurred in neonates with low BW < 2,500g (0.5%) and increased with every additional 500 g of neonatal weight (3.2%, 4.4% and 7.6% in 2,500-2,999g, 3,000-3,499g, ≥3,500g groups respectively, p=0.001). Cephalohematomas were also significantly lower among low BW neonates (0.5% in <2,500gs BW) and increased with every additional 500 g to BW (2.6%, 3.3% and 3.8% in 2,500-2,999g, 3,000-3,499g, ≥3,500g groups respectively, p=0.026). Primary Composite Neonatal Outcome – including head injuries related to birth trauma, fractures of humerus or clavicle and erb's palsy- increased with increasing weight as well (1% among neonates weighing < 2,500g, versus 6.2%, 8.2% and 13.6% in 2,500-2,999g, 3,000-3,499g, ≥3,500g groups respectively, p=0.000). Logistic regression found increasing neonatal weight as a risk factor for subgaleal hematoma and cephalohematoma during vacuum assisted vaginal deliveries. NICU hospitalization rates were highest among neonates weighing <2,500 g (10.1%) compared to the other groups (2.7%, 1.7% and 3.3% in 2,500-2,999g, 3,000-3,499g, ≥3,500g respectively, p=0.000). Vacuum extraction of neonates weighing <2500 g at 34 weeks and beyond seems to be a safe mode of delivery when indicated, with lower rates of head injuries related to birth trauma compared to neonates with higher birth weights.View Large Image Figure ViewerDownload Hi-res image Download (PPT)