Outcomes of very low birth weight infants born by vaginal delivery versus cesarean section

The optimal mode of delivery for very low birth weight (VLBW) infants remains controversial. Despite lacking evidence of benefits regarding neonatal outcomes, ce-sarean section delivery is becoming more prevalent, particularly in early gestational ages. In our retrospective, multicentr study data were collected for very low birth weight infants born in two Croa-tian perinatal regions in a 3 – year period (2014. – 2016.). The final cohort consisted of 255 very low birth weight infants. The rate of delivery via cesarean section was 74.1% (189/255) and is one of the high-est reported in the literature so far. Infants born vaginally were born at an lower gesta-tional age, had lower 1- and 5-minute Ap-gar scores, lower birth weights, and prog-nosis as expressed by higher Clinical risk index for babies (CRIB) scores and were more often born following chorioamnio-nitis and had higher mortality rate until 7 days of hospitalization. Univariate logistic regression analysis showed that cesarean section reduced the risk of death before 7 days of life (OR 0.34 95% CI 0.182-0.667). This significance was lost after multivariate analysis. In infants surviving after 7 days of hospitalization, rates of short-term neona-tal morbidity (severe intracranial hemor-rhage, cystic periventricular leukomalacia (cPVL), late-onset sepsis, necrotizing en-terocolitis, kidney injury and retinopathy of prematurity requiring interventions) were not significant when comparing in-fants born vaginally and those born fol-lowing cesarean section.