title: Mode of Delivery in Premature Neonates: Does It Matter?
abstract: OBJECTIVE
  Despite the current prevalence of preterm births, no clear guidelines exist on the optimal mode of delivery. Our objective was to investigate the effects of mode of delivery on neonatal outcomes among premature infants in a large cohort.
  
  
  METHODS
  We applied a retrospective cohort study design to a database of 6,408 births. Neonates were stratified by birth weight and a composite score was calculated to assess neonatal outcomes. The results were then further stratified by fetal exposure to antenatal steroids, birth weight, and mode of delivery.
  
  
  RESULTS
  No improvement in neonatal outcome with cesarean delivery (CD) was noted when subjects were stratified by mode of delivery, both in the presence or absence of antenatal corticosteroid administration. In the 1,500 to 1,999 g subgroup, there appears to be an increased risk of respiratory distress syndromes in neonates born by CD.
  
  
  CONCLUSIONS
  In our all-comers cohort, replicative of everyday obstetric practice, CD did not improve neonatal outcomes in preterm infants.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Diana A
authors.initials: DA
authors.lastname: Racusin
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Antony
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Haase
authors.affiliation: Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.
authors.forename: Melissa
authors.initials: M
authors.lastname: Bondy
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Kjersti M
authors.initials: KM
authors.lastname: Aagaard
keywords: cesarean delivery; low birth weight; mode of delivery; prematurity