Journal
NEONATOLOGY
Volume 119, Issue 4, Pages 464-473Publisher
KARGER
DOI: 10.1159/000524337
Keywords
Preterm infant; Bronchopulmonary dysplasia; Death; Mode of delivery; C-section; EPICE cohort
Categories
Funding
- European Union [259882, 633724]
- H2020 Societal Challenges Programme [633724] Funding Source: H2020 Societal Challenges Programme
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For premature infants, the mode of delivery is not associated with the incidence of BPD and is not suitable for all women who are considering vaginal delivery. Cesarean section does not reduce the risk of BPD.
Introduction: Bronchopulmonary dysplasia (BPD) represents a tremendous disease burden following preterm birth. The strong association between compromised gas exchange after birth and BPD demands particular focus on the perinatal period. The mode of delivery can impact on lung fluid clearance and microbial colonization, but its impact on BPD and potential trade-off effects between death and BPD are not established. Methods: A total of 7,435 live births (24+0 to 31+6 weeks postmenstrual age) in 19 regions of 11 European countries were included. Principal outcomes were death and BPD at 36 weeks. We estimated unadjusted and adjusted associations with mode of delivery using multilevel logistic regression to account for clustering within units and regions. Sensitivity analyses examined effects, taking into consideration regional variations in C-section rates. Results: Compared to vaginal delivery, delivery by C-section was not associated with the incidence of BPD (OR 0.92, 95% CI: 0.68-1.25) or the composite outcome of death or BPD (OR 0.94, 95% CI: 0.74-1.19) after adjustment for perinatal and neonatal risk factors in the total cohort and in pregnancies for whom a vaginal delivery could be considered. Sensitivity analyses among singletons, infants in cephalic presentation, and infants of >= 26+0 weeks of gestation did not alter the results for BPD, severe BPD, and death or BPD, even in regions with a high C-section rate. Conclusions: In our population-based cohort study, the mode of delivery was not associated with the incidence of BPD. The intention to reduce BPD does not justify a C-section in pregnancies where a vaginal delivery can be considered.
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