Mode of delivery and antenatal steroids and their association with survival and severe intraventricular hemorrhage in very low birth weight infants

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Abstract

Objective:

To determine whether CS delivery and receipt of antenatal steroids (ANS) in vertex-presenting singletons with a gestational age (GA) between 24 and 30 weeks is associated with improved survival and improved severe intraventricular hemorrhage (sIVH)-free survival.

Study Design:

Multicenter cohort, retrospective analysis of prospectively collected data. Vertex-presenting singletons newborns with GA 24 to 30 weeks, birth weight between 500 and 1500 g, without major congenital malformations, born between 2001 and 2011 at Neocosur centers were included.

Results:

Four thousand three hundred and eighty-six infants fulfilled inclusion criteria: 45.8% were delivered vaginally and 54.2% by cesarean section (CS). Newborns delivered vaginally received less ANS, had lower GA, Apgar scores and a lower incidence of survival and sIVH-free survival (P<0.001). Newborns with better survival were those with ANS, independent of mode of delivery. At 24 to 25 weeks GA, increased survival and sIVH-free survival were associated with ANS and CS delivery, compared with those who received ANS and delivered vaginally.

Conclusions:

Among vertex-presenting singletons with GA 24 to 30 weeks, better survival and IVH-free survival were associated with ANS, independent of mode of delivery. In infants at 24 to 25 weeks gestation the combination of ANS/CS was associated with improvement in both outcomes.

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Acknowledgements

We thank Dr Linda Wright for her critical review of this manuscript.

Collaborators from the Neocosur Network Collaborative Group

The following collaborators from the Neocosur Network collaborative group participated in this study: Argentina: Guillermo Colantonio, Jorge Zapata, Gaston Perez, Susana Garcia Ana Pedraza (Clinica y Maternidad Suizo Argentina, Buenos Aires); Isabel Kurlat, Oscar Di Siervi, Adriana Escarate (Hospital de Clinicas Jose de San Martin); Gonzalo Mariani, Jose Maria Ceriani, Silvia Fernandez, Carlos Fustinana, Pablo Brener, Eleonora Edwards (Hospital Italiano, Buenos Aires); Jorge Tavosnaska, Liliana Roldan, Hector Sexer, Gladys Saa, Debora Sabatelli, Maria Laura Gendra, Maria Fernanda Buraschi, Paula Molina (Hospital Juan Fernandez, Buenos Aires); Daniel Agost, Federico Morganti, Adriana Fontana, Daniela Chandias, Monica Rinaldi (Hospital Lagomaggiore, Mendoza); Carlos Grandi, Elio Rojas, Claudio Solana, Ricardo Nieto, Javier Meritano, Miguel Larguia, Laura Kasten, Lucrecia Cuneo (Maternidad Sarda, Buenos Aires); Marcelo Decaro, Lionel Cracco, Gustavo Bassi, Noemi Jacobi, Andrea Brum, Nestor Vain (Sanatorio de la Trinidad, Buenos Aires); Adriana Aguilar, Miriam Guerrero, Edgardo Szyld, Alcira Escandar (Hospital Dr Diego Paroissien, Buenos Aires); Daniel Abdala, MartinGuida, Lucila Ferrin, Horacio Roge (Hospital Español de Mendoza); Gabriel Musante, Maria C. Capelli, Juan Pablo Berazategui, Magdalena de Elizalde, Juan Ignacio Fraga, Rodolfo Keller (Hospital Universitario Austral, Buenos Aires); Luis Ahumada, Mirta Ferreyra (Hospital Nuestra Señora de la Misericordia, Cordoba); Brazil: Vanda Ferreira, Roberta Borges, Marynea Do Vale, Silvia Cavalcante, Joama Gusmao, Patricia Franco, Maria Jose Silva (Hospital Universidad Federal de Maranhao, Sao Luis); Chile: Jorge Fabres, Alberto Estay, Alvaro Gonzalez, Javier Kattan, Mariela Quezada, Soledad Urzua (Hospital Clinico Pontificia Universidad Catolica de Chile, Santiago); Lilia Campos, Lilian Cifuentes, Jorge Leon, Roxana Aguilar, Sergio Treuer, Jimena Giaconi, Aldo Bancalari (Hospital Guillermo Grant, Concepcion); Jane Standen, Marisol Escobar, Viviana Veas, Daniela Sandino (Hospital Gustavo Fricke, Viña del Mar); Agustina Gonzalez, Claudia Avila, Carla Guzman (Hospital San Jose, Santiago); Claudia Toro, Patricia Mena, Beatriz Milet, Enrica Pittaluga (Hospital Dr Sotero del Rio, Santiago); Veronica Peña, Rafael Mendizabal, Dagoberto Pizarro (Hospital San Borja Arriaran, Santiago); Ivonne D’Apremont, Jose L Tapia, Guillermo Marshall, Luis Villarroel, Mariela Quezada, Angelica Dominguez (Unidad Base de Datos, Pontificia Universidad Catolica de Chile, Santiago). Paraguay: Jose Lacarruba, Elizabeth Cespedes, Ramon Mir, Elvira Mendieta, Larissa Genes, Carlos Caballero (Departamento de Hospital de Clinicas de Asuncion). Peru: Veronica Webb, Fabiola Rivera, Margarita Llontop, Sicilia Bellomo, Jaime Zegarra (Hospital Cayetano Heredia, Lima); Oscar Chumbes, Anne Castañeda, Walter Cabrera, Raul Llanos, Jorge Mucha, Gustavo Garcia (Hospital Guillermo Almenara, Lima). Uruguay: Beatriz Ceruti, Daniel Borbonet, Sandra Gugliucci, Ana Lain, Mariza Martinez, Gabriela Bazan, Susana Piffaretti, Isabel Cuña, Patricia Bermudez (Facultad de Medicina Servicio de Recien Nacidos).

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Correspondence to M E Hübner.

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