Survival Advantage Associated With Cesarean Delivery in Very Low Birth Weight Vertex Neonates

Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, California 94304, USA.
Obstetrics and Gynecology (Impact Factor: 4.37). 01/2006; 107(1):97-105. DOI: 10.1097/01.AOG.0000192400.31757.a6
Source: PubMed

ABSTRACT To identify the indications for and any survival advantage associated with very low birth weight (VLBW) neonates delivered by cesarean.
Maternal and infant data from the National Center for Health Statistics linked birth/death data set for 1999 to 2000 were analyzed. Maternal conditions associated with cesarean delivery were compared among birth weight groups for vertex neonates. Birth weight-specific 28-day mortality rates and relative risks were calculated with 95% confidence intervals. Multivariate logistic regression was performed to adjust for other factors that may be associated with survival.
Cesarean delivery occurred frequently, more than 40% in most VLBW birth weight groups. Conditions associated with cesarean delivery in VLBW vertex neonates differed from those seen in non-VLBW vertex neonates. A survival advantage was associated with cesarean delivery in the birth weight analysis up to 1,300 g (P < .05). This decreased mortality for VLBW neonates delivered by cesarean persisted after adjusting for other factors associated with mortality.
Very low birth weight vertex neonates are often born by cesarean delivery and have different maternal risk profiles from non-VLBW vertex neonates born by this route. Neonatal mortality was decreased in VLBW neonates delivered by cesarean. Further study is warranted to determine whether this may be a causal relationship or a marker of quality of care.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective: To investigate the association of perinatal risk factors including delivery mode with mortality in very low birthweight (VLBW) in a tertiary hospital setting. Methods: Medical records of 241 live-born VLBW infants (≤1500 g) were retrospectively reviewed. Details of maternal, obstetrical, perinatal risk factors and their associations with infant mortality were evaluated. Results: The overall infant mortality rate was 23.2%. Mortality was significantly higher for infants born at ≤27 gestational weeks and with a birthweight of ≤750 g (p = 0.000 and p = 0.000, respectively), showing a steep decrease thereafter. On ROC analysis, a cut off of 26.5 weeks was determined for mortality with a sensitivity of 57.1% and a specificity of 90.3% (area under the curve = 0.792, 95% CI: 0.719-0.866). On multivariate regression analysis, gestational week at birth, birthweight, antenatal steroid treatment and pathologic Doppler ultrasound findings were found as independent risk factors for mortality. Conclusions: Gestational week at birth, birthweight and antenatal steroid treatment remain the most important perinatal risk factors for infant mortality in VLBW infants. Mode of delivery does not seem to be associated with mortality when adjusted for other perinatal risk factors.
    Journal of Maternal-Fetal and Neonatal Medicine 09/2014; DOI:10.3109/14767058.2014.953476 · 1.21 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: ObjectiveThis study was conducted to determine the prevalence of low birth weight (LBW) and its related risk factors in an appropriate sample of neonates in Shahroud, northeast Iran.MethodsAt this study, a random sample of 1000 neonates were selected of which 72 neonates were LBWs. We used univariate and multivariate logistic regression methods to evaluate the LBW risk factors in LBWs compared to normal weight infants.Findings7.2% of neonates were LBWs and 6.1% born before 37 weeks of gestation. Prematurity, high-risk pregnancy and maternal age have significant statistical association with LBW. Odds Ratio (OR) for prematurity was 42.82 (95%CI; 21.93-83.57), for high risk pregnancy 2.76 (95%CI; 1.47-5.19) and for maternal age group more than 35 years in comparison to 19-35 years age group 0.2 (95%CI; 0.05-0.71).ConclusionBased on this study; prematurity and high risk pregnancy were the most important risk factors for LBW. There was also a reverse association between maternal age and LBW.
    Iranian Journal of Pediatrics 12/2013; 23(6):701-4. · 0.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare neonatal mortality and neurodevelopmental outcomes at two years of age in very low birth weight infants (≤1500 g) born by cesarean with those by vaginal delivery.
    World Journal of Pediatrics 08/2014; 10(3):227-31. DOI:10.1007/s12519-014-0497-6 · 1.05 Impact Factor