Risk of Intraventricular Hemorrhage in Very Low Birth Weight Infants: Vaginal VS Cesarean Delivery

Abstract 1279 Poster Session II, Sunday, 5/2 (poster 84)

While some studies have found a significant decrease in the incidence and severity of intraventricular hemorrhage (IVH) in the very low birth weight (VLBW) infant who is delivered by cesarean section, the effect of delivery route on the occurrence of IVH remains controversial. We sought to assess the relationship between mode of delivery in VLBW infants and the occurrence of IVH. Methods: case-control study of infants with a birth weight of <1500 grams at a single level III NICU from 7/93-7/98. All live born infants with a minimum of 1 cranial sonogram were included in the analysis. Infants born by cesarean section (n=376) were compared to those born by vaginal delivery (n=293). Data were analyzed using Student's t-test, Chi-square, Mann-Whitney U test, and multivariate logistic regression. All data are expressed as percentage or mean ± SD. A p value < .05 was considered significant. Results: on univariate analysis infants born by cesarean section were less likely to have grade I-IV IVH (n=75, 19%) compared to the infants born vaginally (n=82, 28%, p=.02). However, there was no difference in grade III-IV IVH between the infants born by cesarean section (n=34, 9%) and those born vaginally (n=33, 11%, p=.34). Infants born by cesarean had a significantly higher gestational age (28.7 ± 2.8 vs 27.8 ± 2.8 weeks, p<.01) and were more likely to be diagnosed with intrauterine growth restriction (18% vs 5%, p<.01) than those born vaginally. Furthermore, infants born by cesarean were more likely to have mothers with preeclampsia (25% vs 7.5%, p<.01), to have oligohydramnios (17% vs 7%, p<.01), to be multiple gestation (28% vs 19%, p<.01), and less likely to have premature rupture of membranes (25% vs 49%, p<.01) compared to infants born vaginally. There was no statistical difference in birth weight, antenatal steroid use, chorioamnionitis, gender, race, or Apgar scores between the groups. After controlling for gestational age, intrauterine growth restriction, multiple gestation, preeclampsia, oligohydramnios, premature rupture of membranes, maternal age, premature labor and other potential confounding variables, cesarean delivery was no longer significantly associated with a decreased odds of IVH (odds ratio 0.9, 95% CI 0.6-1.3, p=.56). When the data were analyzed using only infants <26 wks gestation (cesarean n=50,vaginal n=65) using the same potential confounding variables, there was a trend towards increased odds of IVH with cesarean delivery (odds ratio 2.1, 95% CI 0.9-4.9, p=.1). Conclusions: in our population, cesarean delivery does not appear to protect VLBW infants from IVH. Further study with larger number of infants <26wks gestation is needed to determine whether there may be an increased risk of IVH with cesarean delivery in this sub-population.

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Paul, D., Leef, K., Sciscione, A. et al. Risk of Intraventricular Hemorrhage in Very Low Birth Weight Infants: Vaginal VS Cesarean Delivery. Pediatr Res 45, 218 (1999). https://doi.org/10.1203/00006450-199904020-01296

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