No Survival or Morbidity Advantage Associated With Cesarean Section in VLBW Infants

Abstract This study aimed to determine whether CS was associated with survival and/or morbidity advantage. The infants were assigned to group 1 (n = 5,296) and 2 (n = 3,990) with a survival rate of <50% and ≥50%, respectively, at 23-24 gestational weeks (GW) to reduce skewing of the neonatal outcomes by wide institutional variation in the quality of neonatal intensive care. Each group of infants was further stratified into subgroups according to 23-24, 25-26, 27-28 and 29-34 GW. Mortality and major morbidities were measured. While significantly lower overall mortality and morbidity rates including intraventricular hemorrhage were associated with CS than vaginal delivery in both groups, the gestational age-stratified and adjusted odds ratios for mortality and morbidity were not significantly improved with CS. The mortality rate of group 1 was significantly lower than that of group 2 regardless of delivery mode. CS was not associated with survival or morbidity advantage in VLBWIs. The significantly lower mortality in group 1 than in group 2 regardless of delivery mode suggests that the quality level of neonatal intensive care at each institution rather than the mode of delivery might be a prerequisite for the survival and/or morbidity advantage.