Impact of Cesarean Section on Neonatal Mortality Rates Among Very Preterm Infants in the United States, 2000–2003

Malloy, Michael H.

doi:10.1542/peds.2007-2620

Cited by 124 publications

(113 citation statements)

References 32 publications

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“…13 The impact of surgical delivery on mortality in very low birth weight infants is confounded by multiple variables: the maternal risk factors for neonatal morbidity and mortality, the decision of the perinatal team to invest in infants' survival and the different strata of birth weight or gestational age used to analyze the outcome. 5 Lee and Gould reported that Cesarean sections had a significant protective effect, independent of maternal risk factors, for infants with birth weights of 500 to 1499 g, 21 but these results have not been confirmed by other studies. 18,22 A study using US vital statistics data for the years 2000 to 2003 showed that Cesarean section seems to provide survival advantages for infants born from 22 to 25 weeks of gestation, independent of maternal risk factors.…”

Section: Discussionmentioning

confidence: 79%

“…18,22 A study using US vital statistics data for the years 2000 to 2003 showed that Cesarean section seems to provide survival advantages for infants born from 22 to 25 weeks of gestation, independent of maternal risk factors. 5 According to the World Association of Perinatal Medicine, in 2010, Cesarean delivery for fetal indication should be offered 23 for births at 24 weeks and after if there are no severe fetal anomalies or growth restrictions. Proactive management of extreme prematurity R Guinsburg et al…”

Section: Discussionmentioning

confidence: 99%

“…Compared with vaginal delivery, the Cesarean section reduced the risk of neonatal death: the adjusted odds ratios were 0.52, 0.72, 0.81 and 0.92 for 23, 24, 25 and 26 weeks, respectively. 5 In the same study, 8% of the 125 542 live births with 22 to 31 weeks of gestation had Apgar scores <4 at 5 min, which indicates that resuscitation procedures were frequently needed among preterm infants. However, extensive cardiopulmonary resuscitation at birth is also associated with a higher risk of mortality for neonates at the limits of viability.…”

Section: Introductionmentioning

confidence: 87%

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Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists

et al. 2012

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Objective: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death.Study Design: Prospective cohort of 484 infants with 23 0/7 to 26 6/7 weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of X1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life.Result: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/ neonatal clinical conditions. Conclusion:In infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day. Keywords: fetal viability; steroids; cesarean section; cardiopulmonary resuscitation; infant newborn; neonatal mortality Introduction According to the International Liaison Group on Resuscitation, in 2010, 1 for neonates at the margins of viability or those with conditions that predict a high risk of mortality or morbidity, attitudes and practice vary according to region and availability of resources. 2 A systematic review 3 shows that at p22 weeks, no scientific society recommends active treatment for the mother to protect the fetus beyond offering compassionate care. A general agreement is also evident for week 25 0/7 to 25 6/7 : antenatal steroid administration are recommended, prenatal transport and Cesarean section are indicated to protect the fetus and resuscitation is offered to all infants without fatal anomalies. However, there exists a gray area for infants between 23 and 24 weeks, which, in some countries, extends through 25 weeks. 3 The active management of gestations at the limit of viability involves three important clinical decisions: the use of antenatal steroids, delivery method and resuscitation at birth. One prospective cohort study between 1993 and 2007 followed 5476 infants with 23 to 29 weeks gestation admitted for neonatal care. The overall mortality among infants exposed to maternal steroids was lower than in infants not exposed: 19% vs 35% at 24 to 29 weeks and 79% vs 89% at 23 weeks. 4 23, 24, 25 and 26 weeks, respectively. 5 In the same study, 8% of the 125 542 live births with 22 to 31 weeks of gestation had Apgar scores <4 at 5 min, which indicates that resuscitation procedures were frequently needed among preterm infants. However, extensive cardiopulmonary resuscitation at birth

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 87%

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Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists

et al. 2012

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“…Perinatal activity scores were calculated for each health care region on the basis of the frequency of obstetric and neonatal interventions. Some interventions included in the scores (antenatal steroids, 3 surfactant replacement, 4 or delivery at a level III center 5 ) are known to improve outcome, whereas other interventions (eg, cesarean delivery 39 and tocolysis 40 ) may have more questionable effects. The score aimed to reflect overall willingness to intervene actively on behalf of the compromised fetus or infant, not to evaluate the effect of individual interventions.…”

Section: Discussionmentioning

confidence: 99%

Intensity of Perinatal Care for Extremely Preterm Infants: Outcomes at 2.5 Years

et al. 2015

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, for the EXPRESS Study Group abstract OBJECTIVE: To examine the association between intensity of perinatal care and outcome at 2.5 years' corrected age (CA) in extremely preterm (EPT) infants (,27 weeks) born in Sweden during 2004-2007. METHODS: A national prospective study in 844 fetuses who were alive at the mother's admission for delivery: 707 were live born, 137 were stillborn. Infants were assigned a perinatal activity score on the basis of the intensity of care (rates of key perinatal interventions) in the infant's region of birth. Scores were calculated separately for each gestational week (gestational age [GA]-specific scores) and for the aggregated cohort (aggregated activity scores). Primary outcomes were 1-year mortality and death or neurodevelopmental disability (NDI) at 2.5 years' CA in fetuses who were alive at the mother's admission. In health care regions with higher aggregated activity scores, the risk of death or NDI at 2.5 years' CA was reduced in the primary population (aOR: 0.69; 95% CI: 0.50-0.96) and in live-born infants (aOR: 0.68; 95% CI: 0.48-0.95). Risk reductions were confined to the 22-to 24-week group. There was no difference in NDI risk between survivors at 2.5 years' CA.CONCLUSIONS: Proactive perinatal care decreased mortality without increasing the risk of NDI at 2.5 years' CA in EPT infants. A proactive approach based on optimistic expectations of a favorable outcome is justified.

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“…6 It should also be noted that a decision regarding the mode of delivery is separate from the decision to provide lifesustaining interventions to the infant.…”

Section: Advocating For Equality For Preterm Infantsmentioning

confidence: 99%

Advocating for equality for preterm infants

Batton

2013

CMAJ

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Impact of Cesarean Section on Neonatal Mortality Rates Among Very Preterm Infants in the United States, 2000–2003

Abstract: Cesarean section does seem to provide survival advantages for the most immature infants delivered at 22 to 25 weeks of gestation, independent of maternal risk factors for cesarean section.

Cited by 124 publications

References 32 publications

Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists

Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists

Intensity of Perinatal Care for Extremely Preterm Infants: Outcomes at 2.5 Years

Advocating for equality for preterm infants

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