LAUSR

OBJECTIVE The risk of Intraventricular hemorrhage (IVH) and periventricular leukomalacia is associated with low birth weight and gestational age. Caesarean section (CS) may reduce the risk of IVH, although available data has been inconsistent. The aim of this study was to evaluate the influence of the mode of delivery (MOD) on the development of IVH and cystic periventricular leukomalacia (cPVL). STUDY DESIGN We analyzed an initial cohort of 11023 very low birth weight (VLBW) infants born between January 2010 and December 2019. Infants with major malformations and gestational age<23 weeks and ≥32weeks were excluded. A final cohort of 8251 newborns was analyzed. Data was collected from Portuguese National Very-Low-Birth-Weight Registry. Cases were classified as vaginal delivery (VD) or CS. Outcome was assessed in univariate and logistic regression analyses. RESULTS The median gestational age was 29 weeks(IQR 3.3) and the median weight was 1100g(IQR 555). The prevalence of IVH was significantly higher in the VD group vs the CS group, across all grading levels:1144 newborns had grade I IVH(16%VD vs 14%CS,p<0.01), 706 had grade II IVH(12%VD vs 7.6%CS,p<0.01) and 777 had grade III IVH(14%VD vs 7.9%CS, p<0.01). Post-hemorrhagic ventricular dilatation occurred in 457 newborns(8.3%VD vs 4.6%CS,p<0.01) and 456 newborns had periventricular hemorrhagic infarction(8.4% VD vs 4.5% CS,p<0.01). There was no association between MOD and cPVL. After applying a logistic regression analysis, including known risk factors for IVH and cPVL, VD was independently associated with an increased risk of IVH(OR 1.600[1.423-1.799],p < 0.001) and its complications(OR 1.440[1.195-1.735],p<0.001). MOD wasn't associated with an increased risk of cPVL. CONCLUSION Our study suggests that CS is associated with a reduced risk of IVH and its complications in preterm VLBW infants<32 weeks of gestational age. A CS should be considered in this group of infants in order to prevent the development of IVH and its complications.