Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China.
Medicine (Baltimore). 2023 Apr 21;102(16):e33554. doi: 10.1097/MD.0000000000033554.
To estimate the relationship among the cesarean delivery (CD), mortality and morbidity in very low birth weight (VLBW) infants weighing less than 1500 g. This retrospective cohort study enrolled 242 VLBW infants delivered between the 24 to 31week of gestation from 2015 to 2021. We compared CD with vaginal delivery (VD). The primary outcome was a composite neonatal morbidity including bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, late-onset sepsis and retinopathy of prematurity. The secondary outcome included mortality within 28 days. A multivariate logistic regression was used and adjusted for birthweight, twin pregnancy and antenatal steroids intake. The overall CD rate was 80.6%. Compared with VD, a significantly lower composite neonatal morbidity was associated with CD (adjusted odds ratio, 0.33, 95% confidence interval, 0.12-0.90, P = .031). The relationship between CD and neonatal morbidity disappeared when the VLBW infants were stratified according to the gestational age. No significant difference was observed between the VD and CD cohorts regarding mortality. Compared with VD, CD was associated with a lower morbidity in VLBW infants. Further studies are required to clarify how this association is influenced by gestational age.
评估孕 24 周至 31 周、出生体重＜1500g 的极低出生体重儿（VLBW）中行剖宫产术（CD）与死亡率和发病率的关系。
这是一项回顾性队列研究，纳入了 2015 年至 2021 年期间孕 24 周至 31 周、出生体重＜1500g 的 242 例 VLBW 婴儿。比较了 CD 与阴道分娩（VD）的结果。主要结局为包括支气管肺发育不良、脑室内出血、脑室周围白质软化、坏死性小肠结肠炎、晚发性败血症和早产儿视网膜病变在内的新生儿复合发病率。次要结局包括 28 天内的死亡率。采用多变量逻辑回归，并根据出生体重、双胎妊娠和产前皮质类固醇的使用进行调整。
CD 率为 80.6%。与 VD 相比，CD 与复合新生儿发病率显著降低相关（调整优势比，0.33，95%置信区间，0.12-0.90，P=0.031）。当根据胎龄对 VLBW 婴儿进行分层时，CD 与新生儿发病率之间的关系消失。VD 组和 CD 组在死亡率方面无显著差异。与 VD 相比，CD 与 VLBW 婴儿的发病率较低相关。需要进一步的研究来阐明这种关联如何受到胎龄的影响。
