Delivery Mode and Neurological Complications in Very Low Birth Weight Infants

Objective The risk of intraventricular hemorrhage (IVH) and periventricular leuko-malacia is associated with low birth weight and gestational age. Caesarean section (CS)may reduce the risk of IVH, although it has been a matter of debate. The aim of thisstudy was to evaluate the influence of the mode of delivery (MOD) on the developmentof IVH and cystic periventricular leukomalacia (cPVL). Study Design We analyzed an initial cohort of 11,023 very low birth weight (VLBW)infants born between January 2010 and December 2019. Infants with major malfor-mations and gestational age<23 weeks and >= 32 weeks were excluded. Afinal cohortof 8,251 newborns was analyzed. Data was collected from Portuguese National verylow birth weight registry. Cases were classified as vaginal delivery (VD) or CS. Outcomewas assessed in univariate and logistic regression analyses. Results The median gestational age was 29 weeks (IQR 3.3) and the median weight was1,100g (IQR 555).The prevalence of IVHwas significantly higher in the VD groupversus theCS group, across all grading levels:1,144 newborns had grade I IVH (16% VD vs. 14% CS,p<0.01), 706 had grade II IVH (12% VD vs. 7.6% CS,p<0.01), and 777 had grade III IVH (14%VD vs. 7.9% CS,p<0.01). Post-hemorrhagicventricular dilatation occurredin457 newborns(8.3% VD vs. 4.6% CS,p<0.01) and 456 newborns had periventricular hemorrhagicinfarction (8.4% VD vs. 4.5% CS,p<0.01). There was no association between MOD andcPVL. After applying a logistic regression analysis, including known risk factors for IVH andcPVL, VD was independently associated with an increased risk of IVH (odds ratio [OR] 1.600[1.423-1.799],p<0.001) and its complications (OR 1.440[1.195-1.735],p<0.001). MODwas not associated with an increased risk of cPVL. Conclusion Our study suggests that CS is associated with a reduced risk of IVH and itscomplications in preterm VLBW infants<32 weeks of gestational age. A CS should beconsidered in this group of infants to prevent the development of IVH and its complications