Published online May 26, 2009
PEDIATRICS Vol. 123 No. 6 June 2009, pp. e1064-e1071 (doi:10.1542/peds.2008-2407)

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ARTICLE

Incidence of Early Neonatal Mortality and Morbidity After Late-Preterm and Term Cesarean Delivery

Roberta De Luca, MD^a, Michel Boulvain, MD, PhD^b, Olivier Irion, MD^b, Michel Berner, MD^a and Riccardo Erennio Pfister, MD, PhD^a

^a Department of Pediatrics, Neonatology and Pediatric Intensive Care Services
^b Department of Obstetrics and Gynecology, University Hospital of Geneva, and Geneva University, Geneva, Switzerland

OBJECTIVE. To determine the age-stratified risk of intrapartum and neonatal mortality as well as morbidities of clinical relevance after elective cesarean delivery (ECD).

METHODS. This work was a cohort study including 56 549 prospectively recorded late-preterm and term deliveries. We analyzed the effect of cesarean delivery (CD) before the onset of labor on the following multiple neonatal outcomes before hospital discharge, compared with planned vaginal delivery (PVD) and emergency CD: mortality, birth depression, special care admission, and respiratory morbidity. We adjusted for confounders by multivariate analysis and stratified the risk according to gestational age (GA).

RESULTS. Mortality and morbidities had a strong GA-related trend with the lowest incidences consistently found between 38 and 40 weeks of gestation independent of delivery mode. Compared with infants delivered via PVD, infants delivered via ECD had significantly higher rates of mortality (adjusted risk ratio [aRR]: 2.1), risk of special care admission (aRR: 1.4), and respiratory morbidity (aRR: 1.8) but not of depression at birth (aRR: 1.1). Compared with emergency CD, newborns delivered via ECD had less depression at birth (aRR: 0.6) and admission to special care (aRR: 0.8), but mortality (aRR: 0.8) and respiratory morbidity (aRR: 1.0) rates were similar.

CONCLUSIONS. Gestational age–specific risk estimates are lowest between 38 and 40 weeks and should be included in the informed-consent process. The information should also be used to allow for appropriate preparation with respect to adequate staff and equipment. ECD is consistently associated with increased intrapartum and neonatal mortality, risk of admission, and respiratory morbidity compared with PVD and has no advantage over emergency CD in terms of mortality. Neonatal morbidities are lower after ECD than emergency CD only with term births. Our data provide evidence that ECD should not be performed before term.

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Key Words: cesarean delivery • late-preterm newborn • neonates • neonatal mortality • neonatal morbidity

Abbreviations: CD—cesarean delivery • ECD—elective cesarean delivery • VD—vaginal delivery • PVD—planned vaginal delivery • GA—gestational age • RR—risk ratio • aRR—adjusted risk ratio • EmCD—emergency cesarean delivery

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Accepted Jan 30, 2009.

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