Vaginal delivery and neonatal outcome in extremely-low-birth-weight infants below 26 weeks of gestational age

Outcomes of extremely-low-birth-weight infants (ELBW) with gestational age below 26 weeks based on mode of delivery (vaginal versus cesarean delivery) were retrospectively compared. During the observation period (1997 to 2000) 48 ELBW infants, below 26 weeks of gestational age, had been admitted to the Neonatal Intensive Care Unit (NICU) of the Department of Pediatrics, University of Freiburg, Germany. Twenty-seven (56%) patients were born vaginally and 21 (44%) by cesarean section. Birth weight, umbilical artery pH, and rectal temperature were significantly lower in the cesarean than in the vaginal group. Clinical Risk Index for Babies (CRIB) score showed significantly (p < 0.005) higher values in the cesarean group compared with the vaginal group. Hypothermia (rectal temperature below 36.2 degrees C after birth) was more common in the cesarean group (48%) than in the vaginal group (33%). Eighty-five percent of the fetuses in the vaginal group received antenatal corticosteroids and 88% in the cesarean group. Survival rate was significantly (p < 0.05) higher in infants born vaginally (78%) than in the cesarean group (43%). Several complications occurred less frequently after vaginal birth than after cesarean section: intraventricular hemorrhage grade III to IV (18 versus 33%); periventricular leukomalacia (4 versus 14%); and neonatal septicemia (33 versus 52%), but not statistical significant. In our study group, extremely immature preterm infants had a more favorable outcome if they were born vaginally when compared with infants delivered by cesarean section.