Document Detail


Does labor influence neonatal and neurodevelopmental outcomes of extremely-low-birth-weight infants who are born by cesarean delivery?
MedLine Citation:
PMID:  14520225     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to examine the influence of labor on extremely-low-birth-weight infants who were born by cesarean delivery with reference to neonatal and neurodevelopmental outcomes. We hypothesized that infants who are born by cesarean delivery without labor will have better outcomes than those infants who are born by cesarean delivery with labor. STUDY DESIGN: This was a retrospective cohort study of extremely-low-birth-weight infants (birth weight, 401-1000 g) who were born by cesarean delivery and cared for in the National Institute for Child Health and Human Development Neonatal Network, during calendar years 1995 to 1997. A total of 1606 extremely-low-birth-weight infants were born by cesarean delivery and survived to discharge. Of these, 1273 infants (80.8%) were examined in the network follow-up clinics at 18 to 22 months of corrected age and had a complete data set (667 infants were born without labor, 606 infants were born with labor). Outcome variables that were examined include intraventricular hemorrhage grade 3 to 4, periventricular leukomalacia, and neurodevelopmental impairment. RESULTS: Mothers in the cesarean delivery without labor group were older (P<.001), more likely to be married (P<.05), less likely to be supported by Medicaid (P<.01), more likely to have preeclampsia/hypertension (P<.001), more likely to receive prenatal steroids (P<.005), and less likely to have received antibiotics (P<.001). Infants who were born by cesarean delivery without labor had higher gestational age (P<.001), lower birth weight (P<.01), and were less likely to be outborn (P<.001). By univariate analysis, infants who were born by cesarean delivery with labor had a higher incidence of grade 3 to 4 intraventricular hemorrhage (23.3% vs 12.1%, P<.001), periventricular leukomalacia (8.5% vs 4.7%, P<.02), and neurodevelopmental impairment (41.7% vs 34.6%, P<.02). Logistic regression analysis that controlled for all maternal and neonatal demographic and clinical variables that were statistically associated with labor or no labor revealed that the significant differences in grade 3 to 4 intraventricular hemorrhage, periventricular leukomalacia, and neurodevelopmental impairment were no longer evident. CONCLUSION: In extremely-low-birth-weight infants who were born by cesarean delivery and after control for other risk factors, labor does not appear to play a significant role in adverse neonatal outcomes and neurodevelopmental impairment at 18 to 22 months of corrected age.
Authors:
Rajan Wadhawan; Betty R Vohr; Avroy A Fanaroff; Rebecca L Perritt; Shahnaz Duara; Barbara J Stoll; Ronald Goldberg; Abbot Laptook; Kenneth Poole; Linda L Wright; William Oh
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  189     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-10-01     Completed Date:  2003-10-23     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  501-6     Citation Subset:  AIM; IM    
Affiliation:
National Institute for Child Health and Human Development Neonatal Research Network, Bethesda, MD 02905, USA. RWADHAWA@wihri.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Cerebral Hemorrhage / epidemiology
Cesarean Section*
Cohort Studies
Developmental Disabilities / epidemiology
Female
Humans
Incidence
Infant, Low Birth Weight*
Infant, Newborn / growth & development*
Labor, Obstetric / physiology*
Leukomalacia, Periventricular / epidemiology
Logistic Models
Male
Nervous System / growth & development*
Pregnancy
Retrospective Studies
Grant Support
ID/Acronym/Agency:
M01 RR 00070/RR/NCRR NIH HHS; M01 RR 00750/RR/NCRR NIH HHS; M01 RR 06022/RR/NCRR NIH HHS; M01 RR 08084/RR/NCRR NIH HHS; M01 RR00997/RR/NCRR NIH HHS; U01 HD36790/HD/NICHD NIH HHS; U10 HD21364/HD/NICHD NIH HHS; U10 HD21373/HD/NICHD NIH HHS; U10 HD21385/HD/NICHD NIH HHS; U10 HD21397/HD/NICHD NIH HHS; U10 HD21415/HD/NICHD NIH HHS; U10 HD27851/HD/NICHD NIH HHS; U10 HD27853/HD/NICHD NIH HHS; U10 HD27856/HD/NICHD NIH HHS; U10 HD27871/HD/NICHD NIH HHS; U10 HD27880/HD/NICHD NIH HHS; U10 HD27881/HD/NICHD NIH HHS; U10 HD27904/HD/NICHD NIH HHS; U10 HD34216/HD/NICHD NIH HHS; U10 HD40461/HD/NICHD NIH HHS; U10 HD40689/HD/NICHD NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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