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Survival advantage associated with cesarean delivery in very low birth weight vertex neonates
Henry Chong Lee1, Jeffrey B Gould
1Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, California 94304, USA. hclee@stanford.edu
Objective:
To identify the indications for and any survival advantage associated with very low birth weight (VLBW) neonates delivered by cesarean.
Methods:
Maternal and infant data from the National Center for Health Statistics linked birth/death data set for 1999 to 2000 were analyzed. Maternal conditions associated with cesarean delivery were compared among birth weight groups for vertex neonates. Birth weight-specific 28-day mortality rates and relative risks were calculated with 95% confidence intervals. Multivariate logistic regression was performed to adjust for other factors that may be associated with survival.
Results:
Cesarean delivery occurred frequently, more than 40% in most VLBW birth weight groups. Conditions associated with cesarean delivery in VLBW vertex neonates differed from those seen in non-VLBW vertex neonates. A survival advantage was associated with cesarean delivery in the birth weight analysis up to 1,300 g (P < .05). This decreased mortality for VLBW neonates delivered by cesarean persisted after adjusting for other factors associated with mortality.
Conclusion:
Very low birth weight vertex neonates are often born by cesarean delivery and have different maternal risk profiles from non-VLBW vertex neonates born by this route. Neonatal mortality was decreased in VLBW neonates delivered by cesarean. Further study is warranted to determine whether this may be a causal relationship or a marker of quality of care.
Level Of Evidence:
II-2.
