title: The impact of vaginal delivery in premature infants weighing less than 1,251 grams.
abstract: OBJECTIVE
  To evaluate whether mode of delivery is a predictor of poor short-term outcome at different birth weight categories in very low birth weight infants.
  
  
  METHODS
  This study examined a cohort of infants weighing less than 1,251 g born at 2 perinatal centers from January 1, 2000, to December 31, 2003. Outborn infants or those with major anomalies were excluded from the study. Outcome variables included death, severe intraventricular hemorrhage, periventricular leukomalacia (PVL), and combined poor short-term outcomes (death, severe intraventricular hemorrhage, and PVL).
  
  
  RESULTS
  Of the 397 infants who met enrollment criteria, 44% were born vaginally and 56% by cesarean delivery. The proportion of multiparous, breech presentation and prolonged rupture of membranes was significantly different between groups. For infants weighing less than 751 g, the risks of severe intraventricular hemorrhage (41% versus 22%; odds ratio [OR] 2.79, 95% confidence interval [CI] 1.08-7.72) and combined poor short-term outcome (67% versus 41%; OR 2.95, 95% CI 1.25-6.95) were significantly higher if delivered vaginally. Among survivors weighing less than 751 g, the risk of severe intraventricular hemorrhage was higher among those delivered vaginally (24% versus 9%; OR 8.18, 95% CI 1.58-42.20). In infants less 1,251 g who survived, vaginal delivery had a strong association with PVL (5% versus 1%; OR 11.53, 95% CI 1.66-125).
  
  
  CONCLUSIONS
  In infants less than 1,251 g who survived to discharge, vaginal delivery is associated with higher risk for PVL. Furthermore, in infants less than 751 g, vaginal delivery is a predictor for severe intraventricular hemorrhage and combined poor short-term outcome. The negative impact of vaginal delivery mode decreases as birth weight category increases.
authors.affiliation: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Emory University, Atlanta, Georgia, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Deulofeut
authors.forename: Augusto
authors.initials: A
authors.lastname: Sola
authors.forename: Ben
authors.initials: B
authors.lastname: Lee
authors.forename: Susie
authors.initials: S
authors.lastname: Buchter
authors.forename: Mostafizur
authors.initials: M
authors.lastname: Rahman
authors.forename: Marta
authors.initials: M
authors.lastname: Rogido
mesh_terms: D002543:Cerebral Hemorrhage / Q000453:epidemiology; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology*; D019102:Infant, Very Low Birth Weight; D007969:Leukomalacia, Periventricular / Q000209:etiology; D008297:Male; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D012307:Risk Factors