Survival advantage associated with cesarean delivery in very low birth weight vertex neonates.
OBJECTIVE
To identify the indications for and any survival advantage associated with very low birth weight (VLBW) neonates delivered by cesarean.


METHODS
Maternal and infant data from the National Center for Health Statistics linked birth/death data set for 1999 to 2000 were analyzed. Maternal conditions associated with cesarean delivery were compared among birth weight groups for vertex neonates. Birth weight-specific 28-day mortality rates and relative risks were calculated with 95% confidence intervals. Multivariate logistic regression was performed to adjust for other factors that may be associated with survival.


RESULTS
Cesarean delivery occurred frequently, more than 40% in most VLBW birth weight groups. Conditions associated with cesarean delivery in VLBW vertex neonates differed from those seen in non-VLBW vertex neonates. A survival advantage was associated with cesarean delivery in the birth weight analysis up to 1,300 g (P < .05). This decreased mortality for VLBW neonates delivered by cesarean persisted after adjusting for other factors associated with mortality.


CONCLUSIONS
Very low birth weight vertex neonates are often born by cesarean delivery and have different maternal risk profiles from non-VLBW vertex neonates born by this route. Neonatal mortality was decreased in VLBW neonates delivered by cesarean. Further study is warranted to determine whether this may be a causal relationship or a marker of quality of care.


METHODS
II-2.
Lee
Henry Chong
HC
Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, California 94304, USA. hclee@stanford.edu
Gould
Jeffrey B
JB
D000328:Adult; D001724:Birth Weight; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007746:Labor Presentation; D016015:Logistic Models; D008423:Maternal Age; D015999:Multivariate Analysis; D011247:Pregnancy; D011256:Pregnancy Outcome; D011336:Probability; D012042:Registries; D018570:Risk Assessment