Abstract
The optimal mode of delivery for very low birth weight (VLBW) infants remains controversial. Despite lacking evidence of benefts regarding neonatal outcomes, cesarean section delivery is becoming more prevalent, particularly in early gestational ages. In our retrospective, multicentr study data were collected for very low birth weight infants born in two Croatian perinatal regions in a 3 – year period (2014. – 2016.). The fnal cohort consisted of 255 very low birth weight infants. The rate of delivery via cesarean section was 74.1% (189/255) and is one of the highest reported in the literature so far. Infants born vaginally were born at an lower gestational age, had lower 1- and 5-minute Apgar scores, lower birth weights, and prognosis as expressed by higher Clinical risk index for babies (CRIB) scores and were more ofen born following chorioamnionitis and had higher mortality rate until 7 days of hospitalization. Univariate logistic regression analysis showed that cesarean section reduced the risk of death before 7 days of life (OR 0.34 95% CI 0.182-0.667). This signifcance was lost afer multivariate analysis. In infants surviving afer 7 days of hospitalization, rates of short-term neonatal morbidity (severe intracranial hemorrhage, cystic periventricular leukomalacia (cPVL), late-onset sepsis, necrotizing enterocolitis, kidney injury and retinopathy of prematurity requiring interventions) were not signifcant when comparing infants born vaginally and those born following cesarean section.
Highlights
Preterm birth remains the major cause of mortality and long-term morbidity in infancy despite advances in perinatal care. [1] Cesarean section delivery has been proposed as an obstetric strategy to improve neonatal outcome in situations in which preterm delivery is regarded as necessary or inevitable. [2] Several studies aimed to determine whether cesarean section delivery is beneficiary to outcomes of premature infants, but there were no statistically significant differences were found. [3] Despite lacking evidence of benefits regarding neonatal outcomes, cesarean section delivery is becoming more prevalent, in early gestational ages. [4,5] In the discussion regarding obstetric interventions to reduce neonatal morbidity, maternal outcomes must be considered
Compared with infants born via cesarean section, infants born vaginally were born at an lower gestational age (median (24 – 29) vs. (26 – 30), p < 0.001), a worse postnatal condition, as expressed by the 1 – minute Apgar score (median 4 (2 – 7) vs 6 (4 – 9), p
Death before 7 days of hospitalization was higher in infants born vaginally (33.3% vs 14.8%, p = 0.002).The results of the univariate logistic regression showed that risk factors for death before 7 days of hospitalization were gestational age, birth weight, lower 1 – minute, and 5 – minute Apgar score, lower initial pH and higher CRIB scores
Summary
Preterm birth remains the major cause of mortality and long-term morbidity in infancy despite advances in perinatal care. [1] Cesarean section delivery has been proposed as an obstetric strategy to improve neonatal outcome in situations in which preterm delivery is regarded as necessary or inevitable. [2] Several studies aimed to determine whether cesarean section delivery is beneficiary to outcomes of premature infants, but there were no statistically significant differences were found. [3] Despite lacking evidence of benefits regarding neonatal outcomes, cesarean section delivery is becoming more prevalent, in early gestational ages. [4,5] In the discussion regarding obstetric interventions to reduce neonatal morbidity, maternal outcomes must be considered. Preterm birth remains the major cause of mortality and long-term morbidity in infancy despite advances in perinatal care. [1] Cesarean section delivery has been proposed as an obstetric strategy to improve neonatal outcome in situations in which preterm delivery is regarded as necessary or inevitable. [3] Despite lacking evidence of benefits regarding neonatal outcomes, cesarean section delivery is becoming more prevalent, in early gestational ages. A study by Stohl et al [6] found no benefit in very low birth weight (VLBW) singleton infants but rather found higher maternal morbidity with cesarean delivery. Hysterotomy at an early gestational age is associated with an increased risk for short-term maternal complications such as bladder injury or extension to the uterine artery and often requires a vertical uterine incision with its associated increased risk of uterine rupture in subsequent pregnancies. It is doubtful that such studies could be done due to ethical issues. [7] Our study analyzes very low birth weight infants and compares various outcomes between those who were delivered vaginally or abdominally
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