Bauer Jacqueline, Hentschel R, Zahradnik H, Karck U, Linderkamp O
Division of Neonatology, Department of Pediatrics, University of Heidelberg, Germany.
Am J Perinatol. 2003 May;20(4):181-8. doi: 10.1055/s-2003-40608.
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.
基于分娩方式（阴道分娩与剖宫产），对孕周小于26周的极低出生体重儿（ELBW）的结局进行了回顾性比较。在观察期（1997年至2000年），48例孕周小于26周的极低出生体重儿被收治入德国弗莱堡大学儿科新生儿重症监护病房（NICU）。27例（56%）患者经阴道分娩，21例（44%）经剖宫产分娩。剖宫产组的出生体重、脐动脉pH值和直肠温度显著低于阴道分娩组。婴儿临床风险指数（CRIB）评分显示，剖宫产组显著高于阴道分娩组（p<0.005）。剖宫产组体温过低（出生后直肠温度低于36.2摄氏度）比阴道分娩组更常见（48%对33%）。阴道分娩组85%的胎儿接受了产前糖皮质激素治疗，剖宫产组为88%。经阴道分娩的婴儿存活率显著高于剖宫产组（78%对43%，p<0.05）。与剖宫产相比，几种并发症在阴道分娩后发生的频率较低：III至IV级脑室内出血（18%对33%）；脑室周围白质软化（4%对14%）；新生儿败血症（33%对52%），但差异无统计学意义。在我们的研究组中，与剖宫产分娩的婴儿相比，极不成熟的早产儿经阴道分娩时结局更好。
