Lodha Abhay, Ediger Krystyna, Creighton Dianne, Tang Selphee, Lodha Arijit, Wood Stephen
Cumming School of Medicine, University of Calgary, Calgary, Alberta.
Alberta Health Services, Calgary, Alberta.
Paediatr Child Health. 2020 Mar;25(2):93-101. doi: 10.1093/pch/pxz051. Epub 2019 Apr 22.
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.
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).
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.
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.
CS was not associated with increased survival or decreased risk of NDI in premature singleton neonates born at less than 29 weeks' gestation.
关于剖宫产（CS）对单胎早产新生儿长期神经发育结局的益处，目前缺乏相关证据。因此，在早产新生儿分娩的产科最佳实践方面仍存在不确定性。
我们的目的是确定经阴道分娩（VR）、引产剖宫产（CS-L）或未引产剖宫产（CS-NL）的早产单胎新生儿的分娩方式与神经发育结局之间的关联。
对1995年1月至2010年12月出生、孕周小于29周、入住我们新生儿重症监护病房（NICU）并随后在新生儿随访门诊接受评估的单胎新生儿进行研究。主要结局是神经发育障碍（NDI），定义为在矫正年龄36个月时出现脑瘫、认知延迟、严重或轻度视力障碍、听力障碍或失聪。
在这项对1452例新生儿的回顾性队列研究中，1000例符合研究条件，881例（88.1%）可进行随访。VR组、CS-L组和CS-NL组之间的死亡率无显著差异。在3岁时，三组在NDI方面无显著差异。CS-NL组与VR组、CS-L组与VR组出生的新生儿死亡或NDI复合结局的比值比分别为0.90（95%置信区间[CI]：0.59至1.37）和1.08（95%CI：0.72至1.61）。基于倾向评分的配对分析未显示复合结局与引产或未引产剖宫产之间存在显著关联。
对于孕周小于29周出生的早产单胎新生儿，剖宫产与生存率增加或NDI风险降低无关。
