title: Delivery mode and intraventricular hemorrhage risk in very-low-birth-weight infants: Observational data of the German Neonatal Network.
abstract: BACKGROUND
  Very-low-birth-weight infants (VLBWI) are frequently delivered by cesarean section (CS). However, it is unclear at what gestational age the benefits of spontaneous delivery outweigh the perinatal risks, i.e. intraventricular hemorrhage (IVH) or death.
  
  
  OBJECTIVE
  To assess the short-term outcome of VLBWI on IVH according to mode of delivery in a population-based cohort of the German Neonatal Network (GNN).
  
  
  METHODS
  A total cohort of 2203 singleton VLBWI with a birth weight <1500g and gestational age between 22 0/7 and 36 6/7 weeks born and discharged between 1st of January 2009 and 31st of December 2015 was available for analysis. VLBWI were stratified into three categories according to mode of delivery: (1) planned cesarean section (n=1381), (2) vaginal delivery (n=632) and (3) emergency cesarean section (n=190). Outcome was assessed in univariate and logistic regression analyses.
  
  
  RESULTS
  Prevalence of IVH was significantly higher in the vaginal delivery (VD) (26.6%) and emergency CS group (31.1%) as compared to planned CS (17.2%), respectively. In a logistic regression analysis including known risk factors for IVH, vaginal delivery (OR 1.725 [1.325-2.202], p≤0.001) and emergency cesarean section (OR 1.916 [1.338-2.746], p≤0.001) were independently associated with IVH risk. In the subgroup of infants >30 weeks of gestation prevalence for IVH was not significantly different in VD and planned CS (5.3% vs. 4.4%).
  
  
  CONCLUSIONS
  Our observational data demonstrate that elective cesarean section is associated with a reduced risk of IVH in preterm infants <30 weeks gestational age when presenting with preterm labor.
authors.affiliation: Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany. Electronic address: alexander.humberg@uksh.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Humberg
authors.affiliation: Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Härtel
authors.affiliation: Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany.
authors.forename: Pia
authors.initials: P
authors.lastname: Paul
authors.affiliation: Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Hanke
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Bossung
authors.affiliation: Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Hartz
authors.affiliation: Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Fasel
authors.affiliation: Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany; Institute of Medical Biometry and Statistics, University of Luebeck, University Medical Center of Schleswig-Holstein, Campus Luebeck, Germany.
authors.forename: Tanja K
authors.initials: TK
authors.lastname: Rausch
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: Rody
authors.affiliation: Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany.
authors.forename: Egbert
authors.initials: E
authors.lastname: Herting
authors.affiliation: Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Göpel
mesh_terms: D000074042:Cerebral Intraventricular Hemorrhage / Q000453:epidemiology*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology; D019102:Infant, Very Low Birth Weight; D008297:Male; D007752:Obstetric Labor, Premature; D011159:Population Surveillance; D011247:Pregnancy; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors
keywords: Cesarean section; Delivery mode; Premature labor; Spontaneous delivery; Vaginal delivery; Very-low-birth-weight infants