Does delivery mode effect neonatal outcomes in premature infants <30 weeks gestational age?

Öz

Introduction: In recent years, cesarean delivery rates have been increasing in the world and in our country. This situation causes some negative effects on infant and child health in the early neonatal period and later childhood. In this study, we aimed to examine the effect of delivery method on neonatal outcomes in very premature infants. Methods: Premature infants with a gestational age of <30 weeks and a birth weight of 1000-1500 g who were followed at a tertiary neonatal intensive care unit between 2015-2019 were evaluated retrospectively. In order to assess the effects of delivery mode on neonatal outcomes, the study population was divided into 2 groups as those born by vaginal route or cesarean section. Neonatal outcomes of infants were compared according to delivery type. Results: Data of 404 infants were analyzed. The median (min-max) gestational age and birth weight of the study group were 28 (25-29) weeks and 1200 (1000-1500) g, respectively. Seventy (17.3%) infants were born with vaginal route. Demographic characteristics of both groups including median gestational age (28 vs 29 weeks) and birth weight (1200 vs 1195 g) were similar. However, preeclampsia and multiple pregnancy were higher in infants born by cesarean section. (p = <0.001, p = <0.001) Surfactant use was significantly higher in infants born by cesarean section. (55% vs 28.6%; p = <0.001). In addition, it was observed that the use of inotropes in the first week of life was more frequent in infants born by cesarean section. (p=0.001). The need for resuscitation in the delivery room was higher in infants born by cesarean (p=0,021). Also, duration of non-invasive or mechanical ventilation were higher in infants born by cesarean section (p = 0.002, p = 0.001, respectively). Conclusion: Caesarean delivery increases the risk of neonatal morbidity and mortality in very premature infants

Anahtar Kelimeler

• prematurity
• vaginal delivery
• mode of delivery

Gestasyon haftası <30 hafta olan prematüre bebeklerde doğum şekli neonatal sonuçları etkiler mi?

Öz

Giriş: Son yıllarda dünyada ve ülkemizde sezaryen ile doğum oranları giderek artmaktadır. Bu durum, yenidoğan ve sonraki çocukluk döneminde olumsuz bazı etkilere sebep olmaktadır. Bu çalışmada, doğum şeklinin, çok küçük prematüre bebeklerde neonatal sonuçlar üzerine olan etkisinin incelenmesi amaçlanmıştır. Metot: 2015-2019 yılları arasında III. düzey yenidoğan yoğun bakım ünitesinde izlenen, gebelik haftası <30 hafta ve doğum ağırlığı 1000-1500 g olan prematüre bebekler retrospektif olarak değerlendirildi. Doğum şeklinin neonatal sonuçlar üzerine olan etkilerini değerlendirmek için çalışma populasyonu normal vajinal yol (NVY) ve sezaryen (C/S) ile doğanlar olmak üzere 2 gruba ayrıldı. Prematüre bebeklerin neonatal sonuçları doğum şekline göre karşılaştırıldı. Bulgular: Çalışmamızda 404 bebeğin verileri analiz edildi. Çalışma grubunun ortanca (minimum-maksimum) gebelik haftası ve doğum ağırlığı sırasıyla 28 (25-29) hafta, 1200 (1000-1500) g idi. Bebeklerin 70’i (%17,3) NVY ile doğmuştu. Her iki grubun demografik özellikleri incelendiğinde ortanca gebelik haftalarının (28 vs 29) ve doğum ağırlıklarının (1200 vs 1195) benzer olduğu görüldü. Ancak preeklampsi ve çoğul gebelik sezaryen ile doğanlarda daha fazlaydı (p=<0,001; p=<0,001). Sezaryen ile doğan bebeklerde surfaktan kullanımı anlamlı oranda yüksekti. (% 55 vs % 28,6; p=<0,001). Ayrıca sezaryen ile doğan bebeklerde ilk haftada inotrop kullanımının daha sık olduğu görüldü (p=0,001). Doğum salonunda canlandırma ihtiyacı sezaryen ile doğan bebeklerde daha fazla idi (p=0,021). Non invaziv ventilasyon ve mekanik ventilasyon süresi sezeryan ile doğan bebeklerde daha yüksek saptandı (sırasıyla ; p=0,002, p=0,001). Sonuç: Sezaryan ile doğum, çok küçük prematüre bebeklerde neonatal morbidite ve mortalite riskini artırmaktadır.

Anahtar Kelimeler

• prematürite
• vajinal doğum
• doğum şekli

Kaynakça

1. 1. Main DM, Main EK, Maurer MM. Cesarean section versus vaginal delivery for the breech fetus weighing less than 1500 grams. Am J Obstet Gynecol 1983; 146:580–584
2. 2. Malloy MH, Onstad L, Wright E. The effect of cesarean delivery on birth outcome in very low birth weight infants. Obstet Gynecol 1991;77:498–503
3. 3. Faber-Nijholt R, Huisjes HJ, Towen BCL, Fidler VJ. Neurological follow-up of 281 children born in breech presentations: a controlled study. BMJ 1983;286:9–12
4. 4. Kitchen W, Ford GW, Doyle LW, et al. Cesarean section or vaginally delivery at 24 to 48 weeks’ gestation: comparison of survival and neonatal and two-year morbidity. Obstet Gynecol 1985;66:149–157
5. 5. Wolf H, Schaap AHP, Bruinse HW, Smolders-de Haas H, Ertbruggen I, Treffers PE. Vaginal delivery compared with cesarean section in early preterm breech delivery: a comparison of long term outcome. Br J Obstet Gynaecol 1999;106:486–491
6. 6. Jobe, A. H., & Bancalari, E. (2001). Bronchopulmonary dysplasia. American journal of respiratory and critical care medicine, 163(7), 1723–1729.
7. 7. Papile, L. A., Burstein, J., Burstein, R., & Koffler, H. (1978). Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. The Journal of pediatrics, 92(4), 529-534.
8. 8. Barber, E. L., Lundsberg, L. S., Belanger, K., Pettker, C. M., Funai, E. F., & Illuzzi, J. L. (2011). Indications contributing to the increasing cesarean delivery rate. Obstetrics & Gynecology, 118(1), 29-38.

9. 9. Melchor, J. C., Aranguren, G., Lopez, J. A., Avila, M., Fernandez-Llebrez, L., & Linares, A. (1992). Perinatal outcome of very low birthweight infants by mode of delivery. International Journal of Gynecology & Obstetrics, 38(3), 181-187.
10. 10. Ghi, T., Maroni, E., Arcangeli, T., Alessandroni, R., Stella, M., Youssef, A., ... & Pelusi, G. (2010). Mode of delivery in the preterm gestation and maternal and neonatal outcome. The Journal of Maternal-Fetal & Neonatal Medicine, 23(12), 1424-1428.
11. 11. Herbst, A., & Källén, K. (2007). Influence of mode of delivery on neonatal mortality and morbidity in spontaneous preterm breech delivery. European Journal of Obstetrics & Gynecology and Reproductive Biology, 133(1), 25-29.
12. 12. Kayem, G., Baumann, R., Goffinet, F., El Abiad, S., Ville, Y., Cabrol, D., & Haddad, B. (2008). Early preterm breech delivery: is a policy of planned vaginal delivery associated with increased risk of neonatal death?. American journal of obstetrics and gynecology, 198(3), 289-e1.
13. 13. Muhuri, P. K., MacDorman, M. F., & Menacker, F. (2006). Method of delivery and neonatal mortality among very low birth weight infants in the United States. Maternal and child health journal, 10(1), 47-53.
14. 14. Vogl, S. E., Worda, C., Egarter, C., Bieglmayer, C., Szekeres, T., Huber, J., & Husslein, P. (2006). Mode of delivery is associated with maternal and fetal endocrine stress response. BJOG: An International Journal of Obstetrics & Gynaecology, 113(4), 441-445.
15. 15. Ramin, S. M., Porter, J. C., GILSTRAP III, L. C., & Rosenfeld, C. R. (1991). Stress hormones and acid-base status of human fetuses at delivery. The Journal of Clinical Endocrinology & Metabolism, 73(1), 182-186.
16. 16. Mears, K., McAuliffe, F., Grimes, H., & Morrison, J. J. (2004). Fetal cortisol in relation to labour, intrapartum events and mode of delivery. Journal of Obstetrics and Gynaecology, 24(2), 129-132.