title: Neonatal Mortality and Long-Term Outcome of Infants Born between 27 and 32 Weeks of Gestational Age in Breech Presentation: The EPIPAGE Cohort Study.
abstract: OBJECTIVE
  To determine whether breech presentation is an independent risk factor for neonatal morbidity, mortality, or long-term neurologic morbidity in very preterm infants.
  
  
  METHODS
  Prospective population-based cohort.
  
  
  METHODS
  Singletons infants without congenital malformations born from 27 to 32 completed weeks of gestation enrolled in France in 1997 in the EPIPAGE cohort.
  
  
  METHODS
  The neonatal and long-term follow-up outcomes of preterm infants were compared between those in breech presentation and those in vertex presentation. The relation of fetal presentation with neonatal mortality and neurodevelopmental outcomes was assessed using multiple logistic regression models.
  
  
  RESULTS
  Among the 1518 infants alive at onset of labor included in this analysis (351 in breech presentation), 1392 were alive at discharge. Among those eligible to follow up and alive at 8 years, follow-up data were available for 1188 children. Neonatal mortality was significantly higher among breech than vertex infants (10.8% vs. 7.5%, P = 0.05). However the differences were not significant after controlling for potential confounders. Neonatal morbidity did not differ significantly according to fetal presentation. Severe cerebral palsy was less frequent in the group born in breech compared to vertex presentation but there was no difference after adjustment. There was no difference according to fetal presentation in cognitive deficiencies/learning disabilities or overall deficiencies.
  
  
  CONCLUSIONS
  Our data suggest that breech presentation is not an independent risk factor for neonatal mortality or long-term neurologic deficiencies among very preterm infants.
authors.affiliation: INSERM, U-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, DHU Risk in Pregnancy, Paris, France.|Department of Obstetrics, Groupe Hospitalier Paris Saint Joseph, Paris Descartes University, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azria
authors.affiliation: INSERM, U-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, DHU Risk in Pregnancy, Paris, France.|Department of Obstetrics, Groupe Hospitalier Paris Saint Joseph, Paris Descartes University, Paris, France.|Department of Obstetrics and Gynecology, Hôpital Trousseau, Assistance Publique des Hôpitaux de Paris, University Pierre et Marie Curie, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Kayem
authors.affiliation: Department of Gynecology Obstetrics, Strasbourg University Hospitals, Hôpital de Hautepierre, Strasbourg, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Langer
authors.affiliation: INSERM, U-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, DHU Risk in Pregnancy, Paris, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Marchand-Martin
authors.affiliation: Department of Neonatal Medicine, Rouen University Hospital, Rouen, France.|INSERM, AVENIR Research Group & Department of Neonatal Medicine and Intensive Care and Regional Center for Diagnosis and Research on Developmental Language and Behavioural Disorders, Rouen Institute for Biomedical Research, Rouen, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Marret
authors.affiliation: INSERM, U-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, DHU Risk in Pregnancy, Paris, France.|Department of Obstetrics, Groupe Hospitalier Paris Saint Joseph, Paris Descartes University, Paris, France.|Department of Obstetrics and Gynecology, Hôpital Trousseau, Assistance Publique des Hôpitaux de Paris, University Pierre et Marie Curie, Paris, France.|Department of Gynecology Obstetrics, Strasbourg University Hospitals, Hôpital de Hautepierre, Strasbourg, France.|Department of Neonatal Medicine, Rouen University Hospital, Rouen, France.|INSERM, AVENIR Research Group & Department of Neonatal Medicine and Intensive Care and Regional Center for Diagnosis and Research on Developmental Language and Behavioural Disorders, Rouen Institute for Biomedical Research, Rouen, France.|Medical Information Department, Regional Maternity University Hospital, Nancy, France.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Fresson
authors.affiliation: INSERM, U-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, DHU Risk in Pregnancy, Paris, France.|Department of Obstetrics, Groupe Hospitalier Paris Saint Joseph, Paris Descartes University, Paris, France.|Department of Obstetrics and Gynecology, Hôpital Trousseau, Assistance Publique des Hôpitaux de Paris, University Pierre et Marie Curie, Paris, France.|Department of Gynecology Obstetrics, Strasbourg University Hospitals, Hôpital de Hautepierre, Strasbourg, France.|Department of Neonatal Medicine, Rouen University Hospital, Rouen, France.|INSERM, AVENIR Research Group & Department of Neonatal Medicine and Intensive Care and Regional Center for Diagnosis and Research on Developmental Language and Behavioural Disorders, Rouen Institute for Biomedical Research, Rouen, France.|Medical Information Department, Regional Maternity University Hospital, Nancy, France.|Department of Neonatal Medicine, Hôpital Jeanne de Flandre, Lille, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Pierrat
authors.affiliation: INSERM, UMR 1027 Inserm, Toulouse III University, F-31000, Toulouse, France.|Clinical epidemiology unit, University Hospital, F-31000, Toulouse, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Arnaud
authors.affiliation: INSERM, U-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, DHU Risk in Pregnancy, Paris, France.|Department of Obstetrics, Groupe Hospitalier Paris Saint Joseph, Paris Descartes University, Paris, France.|Department of Obstetrics and Gynecology, Hôpital Trousseau, Assistance Publique des Hôpitaux de Paris, University Pierre et Marie Curie, Paris, France.|Department of Gynecology Obstetrics, Strasbourg University Hospitals, Hôpital de Hautepierre, Strasbourg, France.|Department of Neonatal Medicine, Rouen University Hospital, Rouen, France.|INSERM, AVENIR Research Group & Department of Neonatal Medicine and Intensive Care and Regional Center for Diagnosis and Research on Developmental Language and Behavioural Disorders, Rouen Institute for Biomedical Research, Rouen, France.|Medical Information Department, Regional Maternity University Hospital, Nancy, France.|Department of Neonatal Medicine, Hôpital Jeanne de Flandre, Lille, France.|INSERM, UMR 1027 Inserm, Toulouse III University, F-31000, Toulouse, France.|Clinical epidemiology unit, University Hospital, F-31000, Toulouse, France.|Department of Obstetrics and Gynecology, Port-Royal Maternity, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Goffinet
authors.affiliation: INSERM, U-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, DHU Risk in Pregnancy, Paris, France.
authors.forename: Monique
authors.initials: M
authors.lastname: Kaminski
authors.affiliation: INSERM, U-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, DHU Risk in Pregnancy, Paris, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Ancel
mesh_terms: D001946:Breech Presentation / Q000401:mortality* / Q000473:pathology*; D002585:Cesarean Section; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011247:Pregnancy; D012923:Social Class