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Outcome of extremely preterm infants after iatrogenic or spontaneous birth

Tomas Fritz¹, Karin Källén², Karel Maršál³

¹Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.

Acta Obstetricia Et Gynecologica Scandinavica

|May 26, 2018

Insights

The mode of delivery onset (iatrogenic vs. spontaneous) did not impact mortality or morbidity in extremely preterm infants. Gestational age and growth deviation at birth are key factors influencing outcomes for these vulnerable newborns.

Area of Science:

Perinatal Medicine
Neonatology
Public Health

Background:

Preterm birth carries known risks.
Investigated perinatal and infant mortality and morbidity following iatrogenic or spontaneous extremely preterm birth.

Purpose of the Study:

To determine if the mode of onset of delivery influences mortality and morbidity in extremely preterm infants.
To identify factors associated with adverse outcomes in this population.

Main Methods:

Utilized data from the population-based EXPRESS study in Sweden (2004-2007).
Included 682 live-born infants delivered before 27 weeks of gestation with known delivery onset.
Applied multivariate regression models adjusting for gestational age, gender, multiple pregnancy, and birthweight.

Main Results:

No significant differences in intrapartum, early neonatal, or 364-day mortality between iatrogenic and spontaneous delivery onsets after adjusting for gestational age.
Increased risk of severe morbidity, bronchopulmonary dysplasia, and retinopathy of prematurity in the iatrogenic group, which became non-significant after adjusting for weight z-scores.
Spontaneous onset with preterm prelabor rupture of membranes was associated with increased mortality risk.

Conclusions:

The mode of delivery onset (iatrogenic vs. spontaneous) does not appear to affect mortality or morbidity in extremely preterm infants.
Gestational age and growth deviation at birth are more strongly associated with outcomes.
Further research may be needed to understand the impact of specific conditions like preterm prelabor rupture of membranes.

Read full analysis

Abstract

Introduction:

The risks of preterm birth are known. We investigated the perinatal and infant mortality and morbidity after iatrogenic or spontaneous onset of extremely preterm birth.

Material And Methods:

The present study used data from the population-based EXPRESS study comprising all infants delivered before 27⁺⁰ gestational weeks in Sweden between 2004 and 2007. All fetuses alive at admission and with known mode of onset of delivery were included (682 live-born infants; 65 intrapartum deaths). Four multivariate regression models were applied with adjustments for gestational age, fetal gender, multiple pregnancy, and birthweight.

Results:

After adjustment for gestational age, no significant differences were found between iatrogenic and spontaneous onsets of birth regarding intrapartum death, early neonatal death (0-6 d), or death within 364 days. In the group with iatrogenic onset of delivery, there was an increased risk for severe morbidity (odds ratio [OR] 1.86, 95% confidence interval [95% CI] 1.15-3.02), severe bronchopulmonary dysplasia (OR 1.90, 95% CI 1.10-3.26), and retinopathy of prematurity (OR 1.99, 95% CI 1.21-3.27) after adjustment for gestational age, fetal gender, and multiple pregnancy. After additional adjustment for weight z-scores at 36 gestational weeks, the associations were not significant. Within the group with spontaneous onset of delivery, fetuses with preterm prelabor rupture of membranes had increased mortality risk.

Conclusions:

No evidence was found for mode of onset of delivery (iatrogenic vs spontaneous) having an impact on neonatal or infant mortality or morbidity in extremely preterm infants. Instead, gestational age and growth deviation at birth seem to be associated with the outcome.

Keywords:

Extremely preterm birth infant morbidity neonatal morbidity neonatal mortality onset of delivery

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