Delivery mode and risk of intraventricular hemorrhage: A retrospective single-center study on 1760 preterm infants of less than 32 weeks

Objective: To evaluate the association between delivery mode and intraventricular hemorrhage (IVH) in infants with a gestational age (GA) < 32 weeks. Study Design: We retrospectively reviewed data of 1760 infants with a GA between 24+0/7 and 31+6/7 weeks/days born between 01.01.2004 and 31.12.2022. We excluded outborn, congenital malformations, infants born by complicated delivery and without antenatal corticosteroid administration. Exposure was the delivery mode: cesarean section (CS) versus vaginal delivery (VD). IVH within the first week of life was the primary outcome. Multiple regression analyses were used to evaluate the association between delivery mode and IVH. CS infants were also match-paired for GA and small for gestational age (SGA) with VD infants. Results: The incidence of IVH was lower in 1046 CS than in 144 VD study infants (IVH I-IV: 14 vs 29 %, p < 0.001; IVH I-II: 10 vs 22 %, p < 0.001; IVH III-IV: 3 vs 8 %, p = 0.008). CS was associated with a lower risk of IVH grades I-IV (aOR: 0.52, p = 0.012) after the adjustment for GA, year of birth, sex, singleton pregnancy, SGA, hypertensive disorders of pregnancy, pH ≤ 7.00 and/or standard base excess (SBE) ≤ -12 mmol/L at cord blood gas analysis, early-onset sepsis, hemodynamically significant patent ductus arteriosus, thrombocytopenia, need of blood transfusion, mechanical ventilation and inotropes/vasoactive amines. Conclusions: CS was associated with lower risk of IVH than VD in infants with a GA between 24+0/7 and 31+6/7 weeks/days, born by uncomplicated delivery and who have received antenatal corticosteroids.