Arieh Riskin1,2, Shlomit Riskin-Mashiah2,3, Omer Itzchaki2, David Bader1,2, Inna Zaslavsky-Paltiel4, Liat Lerner-Geva4,5, Brian Reichman4,5. 1. Department of Neonatology, Bnai-Zion Medical Center, Haifa, Israel. 2. Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel. 3. Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel. 4. Gertner Institute for Health Policy and Epidemiology, Tel Hashomer, Israel. 5. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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.
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.
Entities:
Keywords:
Cesarean section; mode of delivery; multiple pregnancies; national database; necrotizing enterocolitis; preterm very-low-birth-weight infants