title: No relationship between mode of delivery and neonatal mortality and neurodevelopment in very low birth weight infants aged two years.
abstract: BACKGROUND
  To compare neonatal mortality and neurodevelopmental outcomes at two years of age in very low birth weight infants (≤1500 g) born by cesarean with those by vaginal delivery.
  
  
  METHODS
  In this retrospective, case-control study, we evaluated neonatal mortality, medical conditions and neurodevelopmental outcomes at two years of corrected age in 710 very low birth weight (VLBW) infants born between January 2005 and December 2010. Of the 710 infants, 351 were born by the cesarean and 359/710 by vaginal route.
  
  
  RESULTS
  There were no significant differences in neonatal mortality between the cesarean delivery group and vaginal delivery group [56/351 (15.9%) vs. 71/359 (19.8%), P=0.20]. VLBW infants delivered by the cesarean procedure had a higher incidence of respiratory distress syndrome than those born by the vaginal route [221/351 (63.0%) vs. 178/359 (49.6%), P<0.001]. There were no differences in other neonatal morbidities, including intraventricular hemorrhage [126/351 (35.9%) vs. 134/359 (37.3%), P=0.69], bronchopulmonary dysplasia [39/351 (11%) vs. 31/359 (8.6%), P=0.38] and necrotising enterocolitis [40/351 (11.4%) vs. 32/359 (8.9%), P=0.32] between the two groups. The incidence of poor neurodevelopment after cesarean delivery was similar to that after vaginal delivery [105/351 (29.9) vs. 104/359 (29.0%), P=0.78].
  
  
  CONCLUSIONS
  In neither neurodevelopment nor neonatal mortality did cesarean birth offered significant advantages to VLBW infants. Moreover, the operation might be associated with an increased risk of respiratory distress syndrome for VLBW infants. The mode of delivery of VLBW infants should be largely based on obstetric indications and maternal considerations rather than perceived better outcomes for the neonate.
authors.affiliation: Department of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China.
authors.forename: Jia-Jun
authors.initials: JJ
authors.lastname: Zhu
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Bao
authors.forename: Guo-Lian
authors.initials: GL
authors.lastname: Zhang
authors.forename: Li-Xin
authors.initials: LX
authors.lastname: Ma
authors.forename: Ming-Yuan
authors.initials: MY
authors.lastname: Wu
mesh_terms: D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D002585:Cesarean Section / Q000401:mortality / Q000706:statistics & numerical data*; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000401:mortality / Q000706:statistics & numerical data*; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D011247:Pregnancy; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors