Method of delivery and intraventricular haemorrhage in extremely preterm infants.
OBJECTIVE
It has been reported that caesarean delivery (CD) protects against intraventricular haemorrhage (IVH) in the extremely preterm infant, but it is not known whether this effect involve the more severe grades of IVH. Thus, our aim was to confirm the correlation between the occurrence of IVH and the mode of delivery, and to evaluate this correlation for each grade of IVH.


METHODS
All infants with gestational age (GA) ≤ 28 weeks admitted to the neonatal intensive care unit of a tertiary hospital were studied for each grade IVH and major complications rate.


RESULTS
We found that vaginally born infants had a higher rate of each grade of IVH, but the increase was statistically significant only for grade 3 IVH (18% vs. 2%, p < 0.0001) and all grades IVH (45% vs. 20%, p < 0.0001). Multivariate analysis demonstrated that CD (RR: 0.42, 95% CI 0.28-0.63), birth weight ≥ 800 g (RR: 0.48, 95% CI 0.32-0.73), 27-28 weeks of GA (RR: 0.38, 95% CI 0.25-0.60) and antenatal steroids (0.66, 95% CI 0.22-0.46) decrease independently the risk of developing IVH.


CONCLUSIONS
Our study demonstrates that CD decreases the risk of developing IVH in extremely preterm infants including the most severe grades of IVH.
Dani
Carlo
C
Section of Neonatology, Department of Surgical and Medical Critical Care, Careggi University Hospital of Florence, Florence, Italy. cdani@unifi.it
Poggi
Chiara
C
Bertini
Giovanna
G
Pratesi
Simone
S
Di Tommaso
Mariarosaria
M
Scarselli
Gianfranco
G
Rubaltelli
Firmino F
FF
D001724:Birth Weight; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology*; D015931:Intensive Care, Neonatal; D020300:Intracranial Hemorrhages / Q000453:epidemiology*; D008297:Male; D011247:Pregnancy; D013256:Steroids / Q000008:administration & dosage
D013256:Steroids