Admission and respiratory outcomes of late preterm infants in the setting of high cesarean section deliveries: A single center retrospective analysis

Abstract

Background Late preterm infants (LPIs) account for most preterm births and are at high risk of developing prematurity-related morbidities. Due to the increasing rate of cesarean section delivery, it is expected that more LPIs with respiratory complications will be admitted to neonatal intensive care units (NICU). Objectives To assess the rate of NICU admission and respiratory complications among LPIs and to compare their outcomes based on the mode of delivery. Patients and Methods The list of all LPIs who were admitted in the period 2015–2020 was reviewed. Data collected about demographic characteristics, delivery information, NICU admission, respiratory complications, respiratory support, length of stay, and readmission. Infants were classified according to their mode of delivery into: vaginal delivery group (VD) and cesarean section group (CS). Results Out of 2236 LPIs included, 321 (14%) were born at 34-week gestation, 1137 (51%) were males. 1243 (56%) were admitted to NICU. The CS group comprised 77% (1719) while the VD group 23% (517). Compared to the VD group, infants in the CS group had a higher rate of NICU admission (57.1% vs. 50.7%, P = 0.006), respiratory distress syndrome (RDS) (22% vs. 17%, P = 0.000), and transient tachypnea of newborn (TTN) (17% vs. 11%, P = 0.019). Also, more babies in the CS group received CPAP (36.2% vs. 24.6%, P = 0.000) and surfactant therapy (6.6% vs. 4.6%, P = 0.02). After logistic regression analysis, CS remains an independent factor for NICU admission (OR 1.3, 95% confidence intervals [CI] 1.1–1.6, P = 0.01), respiratory complications (OR 1.6, 95% CI 1.2–2.2, P = 0.001), CPAP requirement (OR 1.6, 95% CI 1.3–2, P = 0.000), and a longer length of stay > 3 days (OR 1.5, 95% CI 1.2–1.8, P = 0.000). Conclusion The rate of CS delivery among late preterm gestation is very high and alarming. CS delivery of LPI increases the rate of NICU admission, respiratory complications, and the need for respiratory support.