Department of Pediatrics, Jeonbuk National University School of Medicine, Jeonju, Korea.
Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.
Sci Rep. 2021 Oct 12;11(1):20264. doi: 10.1038/s41598-021-99563-8.
This study investigated the role of cesarean section (CS) in mortality and morbidity of very-low-birth-weight infants (VLBWIs) weighing less than 1500 g. This nationwide prospective cohort study of the Korean Neonatal Network consisted of 9,286 VLBWIs at 23-34 gestational weeks (GW) of age between 2013 and 2017. The VLBWIs were stratified into 23-24, 25-26, 27-28 and 29-34 GW, and the mortality and morbidity were compared according to the mode of delivery. The total CS rate was 78%, and was directly proportional to gestational age. The CS rate was the lowest at 61% in case of infants born at 23-24 GW and the highest at 84% in VLBWIs delivered at 29-34 GW. Contrary to the significantly lower total mortality (12%) and morbidities including sepsis (21%) associated with CS than vaginal delivery (VD) (16% and 24%, respectively), the mortality in the 25-26 GW (26%) and sepsis in the 27-28 GW (25%) and 29-34 GW (12%) groups were significantly higher in CS than in VD (21%, 20% and 8%, respectively). In multivariate analyses, the adjusted odds ratios (ORs) for mortality (OR 1.06, 95% CI 0.89-1.25) and morbidity including sepsis (OR 1.12, 95% CI 0.98-1.27) were not significantly reduced with CS compared with VD. The adjusted ORs for respiratory distress syndrome (1.89, 95% CI 1.59-2.23) and symptomatic patent ductus arteriosus (1.21, 95% CI 1.08-1.37) were significantly increased with CS than VD. In summary, CS was not associated with any survival or morbidity advantage in VLBWIs. These findings indicate that routine CS in VLBWIs without obstetric indications is contraindicated.
本研究旨在探讨剖宫产术（CS）在体重低于 1500 克的极低出生体重儿（VLBWI）的死亡率和发病率中的作用。这项由韩国新生儿网络进行的全国性前瞻性队列研究纳入了 2013 年至 2017 年期间年龄在 23-34 周（GW）的 9286 例 VLBWI。将 VLBWI 分为 23-24、25-26、27-28 和 29-34 GW 周，并根据分娩方式比较死亡率和发病率。CS 总发生率为 78%，与胎龄直接相关。在 23-24 GW 周出生的婴儿中，CS 率最低，为 61%，在 29-34 GW 周出生的婴儿中，CS 率最高，为 84%。与阴道分娩（VD）相比，CS 与总死亡率（12%）和包括败血症（21%）在内的发病率显著降低（分别为 16%和 24%）相反，在 25-26 GW 周（26%）和 27-28 GW 周（25%）和 29-34 GW 周（12%），CS 的死亡率明显高于 VD（分别为 21%、20%和 8%）。在多变量分析中，与 VD 相比，CS 的死亡率（OR 1.06，95%CI 0.89-1.25）和包括败血症在内的发病率（OR 1.12，95%CI 0.98-1.27）的调整比值比（OR）没有显著降低。CS 与呼吸窘迫综合征（1.89，95%CI 1.59-2.23）和有症状的动脉导管未闭（1.21，95%CI 1.08-1.37）的发生率显著增加。总之，CS 与 VLBWI 的生存或发病率优势无关。这些发现表明，对于没有产科指征的 VLBWI，常规 CS 是不合适的。
