88 - Association between mode of delivery and neonatal outcomes among very preterm infants who received antenatal steroids: a multicenter cohort study in China

Poster Number: 88
Publication Number: 88.438

Qiaolibang Shadike, Department of Neonatology, Urumqi, Xinjiang, China (People's Republic); Xinyue Gu, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Pingyang Chen, The Second Xiangya Hospital, Central South University, ChangSha, Hunan, China (People's Republic); Qianshen Zhang, The Univerisity of Hongkong, Shenzhen Hospital, shenzhen, Guangdong, China (People's Republic); Siyuan Jiang, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Wenhao Zhou, Children's Hospital, Shanghai, Shanghai, China (People's Republic); long li, Children's Hospital of Xinjiang Uygur Autonomous Region, Urumchi, Xinjiang, China (People's Republic)

Background: The optimal mode of delivery(MOD) for very preterm infants (VPIs) remains controversial. Clinical trials of MOD were either inconclusive or terminated prematurely because of insufficient sample size or difficulties of recruitment. Large observational studies may provide useful information about the relative outcomes of very preterm infants (VPI) associated with caesarean section (CS) and vaginal birth (VB).

Objective: To describe the MOD for VPIs admitted to Chinese tertiary Neonatal Intensive Care Units (NICUs) and to compare the neonatal outcomes for VPIs delivered by CS versus VB in a large hospital-based cohort from the Chinese Neonatal Network (CHNN).

Design/Methods: This multicenter retrospective cohort study included 5591 VPIs born at 24+0 - 31+6 weeks of gestation, admitted to NICUs participating in CHNN from January 1st 2019 to December 31st 2019 and born to the mothers who received antenatal steroids before delivery. Delivery via CS was set as exposure while VB was set as control. Both early- and late-stage neonatal outcomes were investigated including NICU death, severe brain impairment, sepsis, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), severe retinopathy of prematurity (ROP), Early death < 7 days, Severe intraventricular hemorrhage Stage 3 or higher (IVH), early-onset sepsis, respiratory distress syndrome (RDS), intensive delivery room resuscitation and two composite outcomes for early- and late-stage separately. Observed incidence rate, crude odds ratios and adjusted odds ratios (aORs) were reported for each outcome. Multivariate logistic regression was used to obtain aORs.

Results: Up to 58.5% VPIs were delivered via CS in our study population, and the rate of CS increased along with the increase of gestation age (table 1). CS was significantly associated with the increased odds of BPD (aOR 1.18, 95%CI 1.02 to 1.38), RDS (aOR 1.55, 95%CI 1.38 to 1.75) and intensive delivery room resuscitation (aOR 1.50, 95%CI 1.30 to 1.73) (table 2). Among subpopulation of singletons, CS was associated with increased odds of NICU death, BPD, RDS, intensive delivery room resuscitation and the composite outcome of overall mortality and five major neonatal morbidities (BPD, IVH, ROP, NEC, sepsis).Conclusion(s): The rate of CS is high among VPIs at 28+0 to 31+6 weeks’ gestation but low among those at 24+0 to 27+6 weeks in China. CS is associated with higher odds of adverse outcomes. Further sensitivity analysis should be done to investigate the impact of mode of delivery among VPIs in different sub-populations, infant presentation at delivery and multiple births.
The cesarean section rates across GA group among very preterm infants with antenatal steroidsAbbreviations: GA,gestational age
Incidence of postnatal outcomes by mode of delivery and Odds ratios (95%C.I.)Abbreviations: CS, cesarean section;VB, vaginal delivery;OR,odds ratios ;NICU,Neonatal intensive care unit;IVH,intraventricular hemorrhage; cPLV,cystic periventricular leukomalacia;NEC,necrotizing small intestine colon;ROP,retinopathy of prematurity;BPD,bronchopulmonary development;cGA,correct gestational age;RDS,respiratory distress syndrome.