Caesarean section and neonatal survival and neurodevelopmental impairments in preterm singleton neonates

Abstract Introduction Evidence is lacking regarding the benefit of caesarean section (CS) for long-term neurodevelopmental outcomes in singleton preterm neonates. Therefore, uncertainty remains regarding obstetrical best practice in the delivery of premature neonates. Objective Our objective was to determine the association between the mode of delivery and neurodevelopmental outcomes in preterm singleton neonates who were delivered by vaginal route (VR), CS with labour (CS-L), or CS without labour (CS-NL). Methods Singleton neonates of less than 29 weeks’ gestation born January 1995 through December 2010 and admitted to our NICU and then assessed at neonatal follow-up clinic were studied. The primary outcome was neurodevelopmental impairment (NDI) defined as cerebral palsy, cognitive delay, major or minor visual impairment, or hearing impairment or deafness at 36 months’ corrected age. Results In this retrospective cohort study of 1,452 neonates, 1,000 were eligible for the study and 881 (88.1%) were available for follow-up. There was no significant difference in mortality between VR group, CS-L group, and CS-NL group. At 3 years, there was no significant difference between the three groups in terms of NDI. The odds of composite outcome of mortality or NDI for neonates born via CS-NL versus VR, and CS–L versus VR were 0.90 (95% confidence interval [CI]: 0.59 to 1.37) and 1.08 (95% CI: 0.72 to 1.61), respectively. Propensity score-based matched-pair analyses did not show a significant association between the composite outcome and CS with or without labour. Conclusions CS was not associated with increased survival or decreased risk of NDI in premature singleton neonates born at less than 29 weeks’ gestation.

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Analysis of intracranial hemorrhage grade in preterm singleton pregnancies delivered vaginally or by cesarean section

Vojnosanitetski pregled ◽

10.2298/vsp1303255l ◽

2013 ◽

Vol 70 (3) ◽

pp. 255-258 ◽

Cited By ~ 1

Author(s):

Sasa Ljustina ◽

Ivana Berisavac ◽

Milica Berisavac ◽

Ljudmila Kovacevic-Vukolic ◽

Vesna Velickovic-Aleksic ◽

...

Keyword(s):

Cesarean Section ◽

Perinatal Outcome ◽

Intraventricular Hemorrhage ◽

Mode Of Delivery ◽

Preterm Neonates ◽

Delivery Methods ◽

Premature Babies ◽

Significant Difference ◽

Vertex Presentation ◽

Singleton Pregnancies

Background/Aim. Preterm birth is the leading cause of neonatal mortality. Periventricular hemorrhage-intraventricular hemorrhage (PVH-IVH) remains a significant cause of both morbidity and mortality in infants prematurely born. The aim of the study was to evaluate the perinatal outcome regarding IVH of premature babies according to the mode of delivery. Methods. A total of 126 women in preterm singleton pregnancies with vertex presentation and 126 neonates weighted from 750 g to 1,500 g at birth were enrolled. The outcomes of 64 neonates born vaginally were compared to 62 neonates born by cesarean section. Results. There was no significant difference in the incidence of IVH among both groups. Conclusion. Our data is consistent with the hypothesis that the mode of delivery does not influence IVH and consenquently perinatal outcome in preterm neonates.

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MODE OF DELIVERY AND ITS IMPACT ON NEONATAL OUTCOMES IN PRETERM INFANTS

Paediatrics & Child Health ◽

10.1093/pch/pxy054.069 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e27-e27

Author(s):

Sarah McKnight ◽

Bishal Gautam ◽

Michael Miller ◽

Bryan S Richardson ◽

Orlando da Silva

Keyword(s):

Caesarean Section ◽

Preterm Infants ◽

Periventricular Leukomalacia ◽

Ductus Arteriosus ◽

Tertiary Care ◽

Mode Of Delivery ◽

Breech Presentation ◽

Neonatal Outcomes ◽

Care Hospital ◽

Significant Difference

Abstract BACKGROUND The optimal mode of delivery for preterm infants remains controversial, and routine Caesarean sections (C/S) are not recommended, except for maternal indications. Nonetheless, many preterm infants are delivered by C/S, particularly those in breech presentation, and recent retrospective data have suggested that these infants may have improved outcomes. OBJECTIVES To examine whether C/S as the mode of preterm delivery is associated with decreased mortality and improved short term outcomes. DESIGN/METHODS This retrospective, population-based cohort study examined infants with a gestational age between 23 0/7 weeks and 32 6/7 weeks, born between January 1, 2007 and December 31, 2016, and admitted to the Neonatal Intensive Care Unit at a single Canadian Tertiary Care hospital. Infants with major congenital anomalies were excluded. Data were abstracted from the local Neonatal-Perinatal database for all infants. Two groups, those delivered vaginally and those delivered by C/S, were compared for major neonatal outcomes including the primary outcomes of death and severe intraventricular hemorrhage (IVH), defined as grade 3 or higher. RESULTS A total of 1442 infants met inclusion criteria (784 born by C/S and 658 vaginally). There was no significant difference in neonatal mortality (7.0% vs 7.1%, p=0.925) or severe IVH (6.1% vs 7.4%, p=0.317). There was, however, a significant difference in the incidence of IVH, any grade (19.9% vs 27.5%, p=0.001), which remained after controlling for other significant predictors. There were no other significant differences in the secondary outcomes examined including need for extensive resuscitation, respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, periventricular leukomalacia, or retinopathy of prematurity. CONCLUSION Caesarean section was not associated with decreased mortality in preterm infants, relative to vaginal births. Caesarean section was associated with a reduced rate of IVH (any grade) and there was a trend towards decreased severe IVH which may warrant further study.

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Neurodevelopmental Outcomes after Neonatal Mechanical Ventilation

QJM ◽

10.1093/qjmed/hcab113.030 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Eman Ahmed Zaky ◽

Hebatallah AM Shaaban ◽

Mohamed OA Dawoud ◽

Kareem SEF Madbouly ◽

Shaymaa M Deifalla

Keyword(s):

Mechanical Ventilation ◽

Rating Scale ◽

Neurodevelopmental Outcomes ◽

Neurodevelopmental Delay ◽

Increased Risk ◽

Study Results ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Significant Difference

Abstract Background A majority of extremely preterm infants are treated with mechanical ventilation, which is associated with an increased risk for future development of chronic lung disease, neonatal brain damage, and neurodevelopmental impairments. Objectives The aim of the current study was to evaluate the current and follow up neurodevelopmental status of an Egyptian sample of newly and previously discharged mechanically ventilated infants following them up for a period of 6 months for the earlier group and a year for the latter. Patients and Methods The current study was designed to be a descriptive study with retrospective (50 infants) and prospective (50 infants) domains. It was carried out on 100 neonates who were recruited from the Pediatric Neonatology Clinic, Children's Hospital and Neonatal Intensive Care Unit, Ain Shams University using clinical evaluation, Bayley Scales of Infant Development, and Childhood Autism Rating Scale (CARS).. Results There was statistically significant negative correlation between CARS score and Bayley Scale by using Composite Score (Cognitive, Language and Motor) on first assessment and follow up in the Prospective group while no correlation was found in the retrospective group. The study results showed that there was no statistical significant difference between two groups as regards gestational age, gender, residency, consanguinity, maternal disease, maturity, mode of delivery, respiratory distress, duration of stay in NICU, duration on mechanical ventilation, weight on admission, audiometry and fundus examination (P > 0.05). Conclusion Using a mechanical ventilator in the neonatal period for a prolonged duration increased the risk for ASD and neurodevelopmental delay. Future studies on large samples are recommended from multicenters to confirm the validity of such findings, Bayley scale is a predicative for neurodevelopmental delay in neonates with long duration stay at NICU especially preterms with low birth weight.

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The Management and Outcome of Higher Order Multifetal Pregnancies: Obstetric, Neonatal and Follow-up Data

Twin Research ◽

10.1375/twin.4.1.4 ◽

2001 ◽

Vol 4 (1) ◽

pp. 4-11

Author(s):

Mark H. Yudin ◽

Elizabeth V. Asztalos ◽

Ann Jefferies ◽

Jon F.R. Barrett

Keyword(s):

Statistical Analysis ◽

Motor Skills ◽

Gestational Age ◽

Neurodevelopmental Outcome ◽

Higher Order ◽

Neurodevelopmental Outcomes ◽

Significant Difference ◽

Before And After

AbstractThe objective of this study was to describe current obstetric, neonatal, and long-term neurodevelopmental outcomes of higher order multifetal gestations (≥ 3 fetuses) in the 1990s. We also intended to identify a target gestational age at which neonatal and neurodevelopmental morbidities are low. Records from all multifetal pregnancies (≥ 3 viable fetuses ≥ 20 weeks gestation) delivered at the two perinatal centers in Toronto, Ontario, Canada during the study period (January 1, 1990–December 31, 1996) were reviewed. Data were collected on obstetric, neonatal, and long-term neurodevelopmental outcomes. Follow up data were gathered regarding the presence of a severe deficit in four categories (vision, hearing, cognition, and motor skills). Statistical analysis was performed to determine a gestational age at which a significant decrease in deficit occurred. During the study period 165 multifetal pregnancies were delivered. This resulted in 511 fetuses, of which 496 were live births. Of these 496 infants, 453 survived to discharge. Follow up data were obtained on 332 (73.3 per cent) infants. Infant survival increased with gestational age, and was approximately 90 per cent or greater at 26 weeks or more. Of all infants followed, the proportion of those without deficit increased with increasing gestational age, such that the per cent without deficit was 96.9 at 31 weeks or greater. Of all infants followed, 301 (90.7 per cent) had no deficit. Statistical analysis revealed a significant difference in long-term neurodevelopmental outcome between infants born before and after 28 weeks gestation. The incidence of a major deficit was 44.1 per cent for those born earlier than and 5.4 per cent for those born later than this gestational age (p = 0.001). In our cohort, survival figures were high. Even in lower gestational groupings, survival was high, but not without serious concerns about severe morbidity. This information is useful when counseling parents of higher order multifetal pregnancies.

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Abstract 2118: A Population-based Comparison of the Cardiovascular Protective Effects of Hydrochlorothiazide and Chlorthalidone

Circulation ◽

10.1161/circ.116.suppl_16.ii_459 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Jeff Nagge ◽

David N Juurlink

Keyword(s):

Confidence Interval ◽

Lower Risk ◽

Primary Outcome ◽

Population Based ◽

Hazard Ratio ◽

Protective Effects ◽

Composite Outcome ◽

Index Event ◽

Significant Difference

Background Clinical practice guidelines for the treatment of hypertension recommend a thiazide diuretic as initial therapy for the majority of patients. Most clinicians consider chlorthalidone (CHL) and hydrochlorothiazide (HCTZ), the two most commonly prescribed thiazides, to be interchangeable, despite evidence suggesting these drugs are not equivalent. Methods We constructed a population-based retrospective cohort study by linking the health records of 1.4 million residents of Ontario, Canada aged 66 or older between July 1, 1993 and March 1, 2002. The index event for entry into the cohort was a new prescription for either HCTZ or CHL. The primary outcome was the time from the index event to a composite outcome of acute myocardial infarction (AMI), stroke, or all-cause mortality. Secondary analyses explored each outcome individually. Analysis was done using Cox proportional hazards regression with the HCTZ group as the reference. Results During 218,360 person-years of follow-up in the HCTZ group, there were 10 025 events (death, AMI or stroke), compared to 113 events during 4,214 person-years of follow-up in the CHL group. The unadjusted hazard ratio for the primary outcome was 0.73 (95% confidence interval 0.61 to 0.88), suggesting a substantially lower risk of events during CHL therapy. After adjustment for differences in baseline demographic and clinical characteristics, there was no statistically significant difference between the groups for the primary outcome (adjusted hazard ratio 0.85; 95% confidence interval 0.71 to 1.03). The hazard ratios for each component of the primary composite outcome all trended in the direction of a lower risk of events in users of CHL. Conclusion In a large cohort of older patients treated with thiazide diuretics, the use of CHL was not associated with a statistically significant reduction in the risk of AMI, stroke, or death. However, treatment effects favored CHL for every outcome, raising the hypothesis that CHL is superior to HCTZ. Further research is needed to confirm or refute this hypothesis.

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Neurodevelopmental Outcomes of Preterm Infants Treated with Oral Paracetamol Versus Ibuprofen for Patent Ductus Arteriosus

American Journal of Perinatology ◽

10.1055/s-0037-1601564 ◽

2017 ◽

Vol 34 (12) ◽

pp. 1185-1189 ◽

Cited By ~ 11

Author(s):

Zeynep Eras ◽

Nurdan Uras ◽

Fuat Canpolat ◽

Omer Erdeve ◽

Serife Oguz ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Infant Development ◽

Controlled Trial ◽

Ductus Arteriosus ◽

Neurodevelopmental Outcomes ◽

Significant Difference ◽

Oral Ibuprofen ◽

Patent Ductus

Objective This study aims to determine the effects of paracetamol versus ibuprofen treatment given to preterm infants for the pharmacological closure of patent ductus arteriosus (PDA) on neurodevelopmental outcomes at 18 to 24 months' corrected age. Method A follow-up study was conducted to evaluate the neurodevelopmental outcomes of preterm infants (gestational age ≤ 30 weeks) enrolled in a randomized controlled trial comparing oral paracetamol versus oral ibuprofen for the closure of PDA. The developmental assessment was done by using “Bayley Scales of Infant Development, Second Edition” at 18 to 24 months' corrected age. Results A total of 80 infants completed the trial protocol. Of the 75 infants eligible for follow-up, 61 infants (30 in the paracetamol group and 31 in the ibuprofen group) were evaluated. There was no significant difference in neurodevelopmental outcomes between the two groups. Conclusion The neurodevelopmental outcomes did not differ among the preterm infants who receive either paracetamol or ibuprofen at 18 to 24 months' corrected age.

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Comparison of clinical outcomes following CuT-380A insertion in postplacental period with interval insertion

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20174071 ◽

2017 ◽

Vol 6 (9) ◽

pp. 4111

Author(s):

Divya Chauhan ◽

Shalini Gainder

Keyword(s):

Caesarean Section ◽

Vaginal Delivery ◽

Mode Of Delivery ◽

Abnormal Uterine Bleeding ◽

Complication Rates ◽

Expulsion Rate ◽

Interval Group ◽

Obstetrics And Gynaecology ◽

Significant Difference ◽

A Prospective Study

Background: Postplacental intra-uterine device has many benefits like providing contraception immediately after childbirth, non-interference with lactation and high efficacy. However, concerns about its safety have led to decreased use of this method of contraception. Hence, this study aims to compare the complication rates following insertion of immediate postplacental IUCD (PPIUCD) with interval insertion.Methods: This is a prospective study conducted under the Department of Obstetrics and Gynaecology in PGIMER, Chandigarh. 196 women were included in the study. Women were divided in two groups, those who were inserted with immediate postplacental IUCD versus those who had IUCD insertion in interval period. The two groups were followed up for a period of 6 months and complications were recorded. The PPIUCD group was further subdivided into 2 subgroups based on mode of delivery, vaginal delivery and caesarean section. These PPIUCD subgroups were also compared.Results: There was no statistically significant difference in the incidence of pelvic pain, infection, abnormal uterine bleeding and expulsion between the PPIUCD and interval group. However, when the PPIUCD subgroups were compared, it was seen that no woman in caesarean section subgroup had expulsion of IUCD whereas 9.8% women had expulsion in the vaginal delivery PPIUCD subgroup.Conclusions: Postplacental and interval IUCD seem to be comparable for the incidence of various complications. However, intra-caesarean PPIUCD insertion seems to have a much lower expulsion rate as compared to vaginal delivery PPIUCD insertion.

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Antenatal corticosteroids for impending late preterm (34-36+6 weeks) deliveries—A systematic review and meta-analysis of RCTs

PLoS ONE ◽

10.1371/journal.pone.0248774 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248774

Author(s):

Mangesh Deshmukh ◽

Sanjay Patole

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Neonatal Resuscitation ◽

Late Preterm ◽

Respiratory Support ◽

Preterm Neonates ◽

Antenatal Corticosteroids ◽

Neurodevelopmental Outcomes ◽

Level Of Evidence

Background Administration of antenatal corticosteroids (ANC) for impending preterm delivery beyond 34 weeks of gestation continues to be a controversial issue despite various guidelines for obstetricians and gynaecologists. Objective To compare outcomes following exposure to ANC for infants born between 34–36+6 weeks’ gestation. Methods A systematic review of randomised controlled trials (RCT) reporting neonatal outcomes after ANC exposure between 34–36+6 weeks’ gestation using Cochrane methodology. Databases including PubMed, Embase, Emcare, Cochrane Central library and Google Scholar were searched in May 2020. Primary outcomes: (1) Need for respiratory support (Mechanical ventilation, CPAP, high flow) or oxygen (2) Hypoglycemia. Secondary outcomes included respiratory distress syndrome (RDS), transient tachypnoea of newborn (TTN), need for neonatal resuscitation at birth [only in the delivery room immediately after birth (not in neonatal intensive care unit (NICU)], admission to NICU, mortality and developmental follow up. Level of evidence (LOE) was summarised by GRADE guidelines. Main results Seven RCTs (N = 4144) with low to high risk of bias were included. Only one RCT was from high income countries, Meta-analysis (random-effects model) showed (1) reduced need for respiratory support [5 RCTs (N = 3844); RR = 0.68 (0.47–0.98), p = 0.04; I2 = 55%; LOE: Moderate] and (2) higher risk of neonatal hypoglycaemia [4 RCTs (N = 3604); RR = 1.61(1.38–1.87), p<0.00001; I2 = 0%; LOE: High] after ANC exposure. Neonates exposed to ANC had reduced need for resuscitation at birth. The incidence of RDS, TTN and surfactant therapy did not differ significantly. None of the included studies reported long-term developmental follow up. Conclusions Moderate quality evidence indicates that ANC exposure reduced need for respiratory support, and increased the risk of hypoglycaemia in late preterm neonates. Large definitive trials with adequate follow up for neurodevelopmental outcomes are required to assess benefits and risks of ANC in this population.

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Comparative study of early neonatal outcome in low birth weight babies in hypertensive disorders complicating pregnancies with the mode of delivery

Indian Journal of Obstetrics and Gynecology Research ◽

10.18231/j.ijogr.2021.071 ◽

2021 ◽

Vol 8 (3) ◽

pp. 339-345

Author(s):

Sivajyothi Pilli ◽

Kavitha Bakshi

Keyword(s):

Birth Weight ◽

Caesarean Section ◽

Low Birth Weight ◽

Vaginal Delivery ◽

Caesarean Delivery ◽

Neonatal Outcome ◽

Mode Of Delivery ◽

Survival Advantage ◽

Hypertensive Disorders ◽

Significant Difference

Pregnancy induced Hypertension (PIH) is strongly associated with intrauterine fetal growth restriction (IUGR), low birth weight (LBW) and admission to NICU. PIH is not by itself an indication for caesarean delivery. However, the incidence of caesarean is high because of the development of complications in mother and the need to deliver prematurely. To compare the immediate morbidity and survival advantage of LBW vertex presenting babies with the mode of delivery in hypertensive disorders complicating pregnancies. This was a comparative cross-sectional study done on women admitted to the labour ward during the study period with PIH delivering a baby through either a vaginal delivery or a caesarean section with a birthweight of <2.5kgs. A detailed history taking and clinical examination was done. Babies were followed up for one week following delivery to note down the early neonatal outcome. In this study, over all there was no statistically significant difference in neonatal outcome in both vaginal delivery and caesarean section groups. However, there was slight increased incidence of prematurity (68% vs 64%), Birth Asphyxia (14% vs 8%), Sepsis (8% vs 6%), IVH (6% vs 2%) and Hyperbilirubinemia (16% vs 14%) in vaginal delivery group. While, RDS (20% vs 14%) and NEC (4% vs 2%) had higher incidence in caesarean delivery group. Overall, prematurity and IUGR resulting in LBW, contributed to these neonatal complications. Caesarean delivery offers no short-term survival advantage compared with vaginal delivery for LBW vertex presenting foetuses in PIH patients. Neonatal outcomes are not worsened by spontaneous or induced vaginal delivery in women with hypertension with good control and also decreases morbidity due to caesarean section to the mother.

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Abstract 13400: Patients Less Than or Equal to 2.5kg Have Higher Morbidity and Mortality After Norwood-sano Palliation

Circulation ◽

10.1161/circ.142.suppl_3.13400 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Konstantin Averin ◽

Lindsay Ryerson ◽

Morteza Hajihosseini ◽

Irina A Dinu ◽

Darren H Freed ◽

...

Keyword(s):

Chromosomal Abnormalities ◽

Morbidity And Mortality ◽

Norwood Operation ◽

Neurodevelopmental Outcomes ◽

Low Weight ◽

Significant Difference ◽

Motor Outcomes ◽

Cardiac Diagnosis

Introduction: In patients with single ventricle heart disease, prematurity and low weight at the Norwood operation are risk factors for mortality. Reports assessing peri-operative and long-term outcomes of Norwood palliation in patients ≤ 2.5kg are limited. Methods: All patients who underwent Norwood-Sano procedure between 2005-2020 were identified. Patients ≤ 2.5kg at the time of the Norwood operation (cases) were matched 1:3 with patients ≥ 3.0 kg (comparisons) for year of surgery and cardiac diagnosis. Demographic and peri-operative characteristics, survival to hospital discharge and 2-year neurodevelopmental outcomes were compared. Results: Twenty-seven cases (mean±SD weight 2.2±0.3 kg, mean age 15.6±14.1 days at surgery) and 81 comparisons (mean weight 3.5±0.4 kg, mean age 10.9±7.9 days at surgery) were identified. There was no statistically significant difference in the presence of chromosomal abnormalities (7.4% vs. 12.3%, p=0.485), prenatal diagnosis made (88.9% vs. 75.3%, p=0.141), or duration of cardiopulmonary bypass (140.7±65.6 vs. 121.3±42.3 min, p=0.068) between cases and comparisons, respectively. Cases had a longer time to post-operative lactate < 2 mmol/L (33.1±27.5 vs. 17.9±12.2 hours, p<0.001), longer duration of ventilation (30.5±24.5 vs. 18.6±17.5 days, p=0.005), higher need for dialysis (48.1% vs. 19.8%, p=0.007) and greater need for extracorporeal membrane oxygenation support (29.6% vs. 12.3%, p=0.004). Cases also had significantly higher in-hospital (25.9% vs. 1.2%, p<0.001) and 2-year (59.2% vs. 11.1%, p<0.001) mortality. The 2-year Bayley Scales of Infant and Toddler Development, III, was completed on all living cases (n=11) and most comparisons (n=63; 1 refusal and 8 too young); delay, a score of < 70, showed the following differences between cases vs. comparisons for cognitive (86.9 vs. 91, p=0.363), language (84.9 vs. 88.2, p=0.494) and motor (73.6 vs. 87.3, p=0.013). Conclusions: Patients ≤ 2.5kg at the time of Norwood-Sano have significantly higher post-operative morbidity and mortality up to 2-year follow-up, and worse 2-year neurodevelopmental motor outcomes. Additional studies are warranted to assess the outcome of alternative therapeutic options in this patient population.

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