Neonatal morbidity and mortality by mode of delivery in very preterm neonates

Zahedi-Spung, Leilah; Raghuraman, Nandini; Macones, George A.; Cahill, Alison G.; Rosenbloom, Joshua I.

doi:10.1016/j.ajog.2021.07.013

Cited by 14 publications

(29 citation statements)

References 24 publications

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“…36,37 In our analysis, a preventive factor for brain injuries in general, and particularly IVH, was cesarean delivery. Although several studies suggest that cesarean delivery may be associated with better outcomes and fewer brain injuries in infants with very low birth weight, [38][39][40] we acknowledge that conflicting reports exist. For example, Zhu et al 41 showed no difference in IVH rate and neurodevelopmental outcome between delivery modes in their collective of patients born preterm.…”

Section: Original Articlesmentioning

confidence: 84%

Routine Use of Cerebral Magnetic Resonance Imaging in Infants Born Extremely Preterm

Buchmayer

Kasprian

Giordano

et al. 2022

The Journal of Pediatrics

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Section: Original Articlesmentioning

confidence: 84%

Routine Use of Cerebral Magnetic Resonance Imaging in Infants Born Extremely Preterm

Buchmayer

Kasprian

Giordano

et al. 2022

The Journal of Pediatrics

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“…13 The uncertain neonatal benefit and clear maternal risk of cesarean delivery at 22 weeks have been highlighted in several retrospective cohorts that did not show the long-term benefit of cesarean. 1 11 12 Conversely, Czarny et al in a population-based cohort of 15,775 deliveries from 22 to 23 weeks found cesarean delivery was associated with a modest increase in fetal survival at 1 year; however, after controlling for antenatal corticosteroids, the relationship was no longer significant (aRR = 1.2, CI: 0.9 − 1.4). 5 Additionally, only 12% of maternal-fetal medicine specialists surveyed would perform cesarean delivery at 22 weeks if the patient desired resuscitation.…”

Section: Discussionmentioning

confidence: 99%

“…6 7 8 Periviable cesarean delivery often involves an incision into the contractile portion of the uterus, limits the patient's ability for the future trial of labor, and commits her to an earlier repeat cesarean in future pregnancies. 9 Due to controversy regarding the benefit of cesarean at the extremes of prematurity, 1 10 11 12 consensus guidelines endorsed by the American College of Obstetrics and Gynecologists and the Society for Maternal-Fetal Medicine 13 do not recommend cesarean at 22 0/7 to 22 6/7 weeks. Still, recent data suggest that cesarean in the periviable period may be increasing.…”

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confidence: 99%

The Impact of Mode of Delivery on Maternal and Neonatal Outcomes during Periviable Birth (22–25 Weeks)

et al. 2022

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Objective: To compare the maternal and neonatal complications of periviable birth by delivery route. Study Design: A retrospective cohort study of periviable deliveries (22w0d-25w6d) from 2013-2020 at a tertiary teaching institution was conducted. Deliveries were grouped by mode of delivery. Excluded deliveries included pregnancy termination, anomaly, or undesired neonatal resuscitation. The primary composite maternal outcome included death, intensive care admission, sepsis, surgical site infection, unplanned operation, or readmission. Secondary outcomes included maternal blood loss, length of stay, neonatal survival, bronchopulmonary dysplasia (BPD), interventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA), and retinopathy of prematurity (ROP). Outcomes were compared using student t-test, Wilcoxon-Mann-Whitney, and chi-squared tests. Relative risk (RR) and 95% confidence intervals (CI) were calculated with log binomial regression. P-values <0.05 were considered significant. Demographic and intervention variables associated with the outcome and the exposure were included in an adjusted relative risk (aRR) model. Subgroup analyses of singleton pregnancies and 22w0d-23w6d deliveries were conducted. Results: After exclusion, 230 deliveries were included in the cohort. Maternal characteristics were similar between cohorts. For the primary outcome, cesarean delivery was associated with a trend toward increased maternal morbidity (22.6% vs 10.7%, RR 2.11 [1.03-4.43] p-value 0.03, aRR 1.95 [0.94-4.03], p-value 0.07). Administration of magnesium sulfate, antenatal corticosteroids, and tocolytics were similar between cohorts. Neonatal survival to discharge was not different between the groups (54/83, 65.1% vs 118/191, 61.8%, aRR 0.93 [0.77-1.13]). Among the 172 neonates discharged alive, there was no difference in BPD, IVH, NEC, PDA, ROP, or intact survival. Conclusion: Periviable birth has a high rate of maternal morbidity with a trend toward higher risk following cesarean delivery. These risks should be included in shared decision making.

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“…A growing body of evidence in the literature shows that compared to vaginal delivery, the CD is not protective in the peri-viable period. For example, a retrospective cohort study on 271 singleton pregnancies delivered between 22 to 29 weeks revealed that CD performed for standard obstetrical indications is associated with an increase in immediate survival, but it is not associated with an overall decrease in morbidity or mortality ( 32 ). Another study found no differences in neurodevelopment at 2 years of age in 158 neonates delivered through vaginal delivery and CD at the time of peri-viability ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

Partial vs. complete course of antenatal corticosteroid prophylaxis: An Italian single center retrospective study

Xodo

Trombetta²,

Celante³

et al. 2022

Front. Pediatr.

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IntroductionThis study aimed to compare the outcomes of preterm infants given 12 vs. 24mg of betamethasone prophylaxis to understand whether a partial course of antenatal corticosteroids (CCS) could prevent or mitigate the major preterm birth complications.MethodsThis is a retrospective single-center cohort study including neonates born between 24 and 34 weeks of gestation from 2001 to 2019 at the University Hospital of Udine. The study population was divided into two groups: one group received 12mg, and another received a 24mg dose of betamethasone before the delivery. A separate analysis was performed for single and multiple pregnancies. The two groups were evaluated for various neonatal outcomes.ResultsThe study population included a total of 1,258 pregnancies and 1,543 neonates delivered between 24 and 34 weeks of gestation, of which 1,022 (803 single and 219 multiple pregnancies) were exposed to the complete CCS prophylaxis, whereas 236 (192 single and 44 multiple pregnancies) received the incomplete CCS prophylaxis. In single pregnancies, as for maternal characteristics, the most significant differences observed between the two groups are the following: a higher prevalence of spontaneous vaginal deliveries in the incomplete CCS prophylaxis (36.46 vs. 23.91%) and, by contrast, a higher prevalence of cesarean deliveries in the complete CCS prophylaxis group (75.72 vs. 63.02%). As for neonatal outcomes, the low Apgar score in the first and fifth min was significantly more prevalent in the incomplete CCS prophylaxis group compared with the complete CCS prophylaxis group. The group of incomplete CCS prophylaxis reported a higher occurrence of the following outcomes: IVH grade 3-4 (7.81 vs. 3.74%, p < 0.05), PVL (7.29 vs. 1.99% p < 0.05), ROP (23.96 vs. 18.06% p = 0.062), and RDS (84.38 vs. 78.83% p = 0.085). After adjusting for covariates, the complete CCS prophylaxis group in single pregnancies was significantly protective for IVH grade 3-4, PVL, and low Apgar's scores. Similar results were found in multiple pregnancies except for RDS.DiscussionThis retrospective single-center cohort study found that, compared with preterm infants treated with 24mg betamethasone in utero, those given half course of betamethasone had a significantly higher prevalence of IVH grade 3-4, PVL, RDS, and lower Apgar scores at 1 and 5 min. In conclusion, the evidence from this single-center retrospective study supports the preference for the complete CCS prophylaxis in women at risk of preterm birth because of its beneficial effect on the main adverse outcomes.

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Neonatal morbidity and mortality by mode of delivery in very preterm neonates

Cited by 14 publications

References 24 publications

Routine Use of Cerebral Magnetic Resonance Imaging in Infants Born Extremely Preterm

Routine Use of Cerebral Magnetic Resonance Imaging in Infants Born Extremely Preterm

The Impact of Mode of Delivery on Maternal and Neonatal Outcomes during Periviable Birth (22–25 Weeks)

Partial vs. complete course of antenatal corticosteroid prophylaxis: An Italian single center retrospective study

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