Mode of delivery and necrotizing enterocolitis in very preterm very-low-birth-weight infants

Abstract

Objective

To investigate the association between delivery mode and necrotizing enterocolitis (NEC) in very preterm (24–31 weeks’ gestational age (GA)) very-low-birth-weight (VLBW) (≤1500 g) infants.

Design

Population-based observational study using univariate and multivariable logistic regression analyses.

Setting

The Israel National VLBW infant database 1995–2015.

Patients

20,223 VLBW infants, 11,832 singletons and 8391 multiples.

Main outcome measures

The association of NEC occurrence to delivery by cesarean section (CS) in singletons and multiples VLBW very preterm infants.

Results

NEC occurred in 7.6% of singletons and 6.4% of multiples. 71.5% were delivered by CS (64.7% of singletons, 80.9% of multiples). CS delivery was not significantly associated with NEC stages 2–3 in singletons; but multiple births CS were associated with significantly higher odds for NEC (OR 1.31, 95% CI 1.01–1.69). Odds for NEC were greater with lower GA, small for GA (SGA) and patent ductus arteriosus (PDA) in both singletons and multiples, and lower in multiples with antenatal corticosteroids.

Conclusions

We demonstrated association between deliveries by CS and increased risk for NEC only in multiple pregnancies.

Keywords:

• Cesarean section
• mode of delivery
• multiple pregnancies
• national database
• necrotizing enterocolitis
• preterm very-low-birth-weight infants

Acknowledgements

Authorship: All listed authors meet the International Committee of Medical Journal Editors (ICMJE) requirements for authorship.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The Israel National Very Low Birth Weight Infant Database is partially funded by the Israel Center for Disease Control and the Ministry of Health.