ORIGINAL RESEARCH article
Front. Public Health
Sec. Children and Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1671581
This article is part of the Research TopicPublic Health Innovations for Enhancing Newborn and Maternal Well-BeingView all 6 articles
The Delivery Modes and Morbidity/Mortality in Very Preterm Infants with Birth Weight <1500 g: A retrospective Cohort Study
Provisionally accepted
- 1Sichuan University West China Second University Hospital Department of Neonatology, Chengdu, China
- 2Sichuan University Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects, Chengdu, China
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Abstract Introduction: Compare outcomes of very preterm infants (VPIs) with a birth weight<1500 g based on delivery mode and propensity score matching (PSM). Methods: This was a retrospective study (2016–2021) of 1375 VPIs (692 vaginal and 683 cesarean deliveries). PSM created 390 matched pairs. Outcomes included respiratory and neurological morbidity and mortality. Results: PSM revealed no significant difference between the two groups at baseline or after antenatal corticosteroids administration. The incidence rates of birth asphyxia, delivery room resuscitation, neonatal respiratory distress syndrome, use of pulmonary surfactants, pulmonary hemorrhage, and use of invasive ventilation in the vaginal delivery group after PSM were 42.3%, 68.2%, 65.9%, 59.2%, 7.2%, and 36.7%, respectively. These rates were significantly lower than those in the cesarean delivery group (52.3%, 83.3%, 79.5%, 70.8%, 14.4%, and 51.8%, respectively) (P<0.05). The difference was more significant in infants with a gestational age of 28–31+6 weeks (P<0.05). There were no significant differences in the incidence rates of intraventricular hemorrhage (IVH), severe IVH, periventricular leukomalacia, bronchopulmonary dysplasia, necrotizing enterocolitis (NEC), NEC surgery, premature infant retinopathy (ROP), severe ROP, late-onset neonatal sepsis, or mortality between the two groups. The mortality rate within three days in the vaginal delivery group was 7.7%, which was higher than that in the cesarean delivery group (3.3%), primarily in infants with a gestational age < 28 weeks (P<0.05). Conclusion: Cesarean section reduced early mortality in VPIs <28 weeks but increased respiratory morbidity at 28–31+6 weeks, with no impact on other outcomes. Since 52.1% of the cesarean sections were emergency procedures, this may have biased the results.
Keywords: Very preterm infants, vaginal delivery, Cesarean delivery, Mortality, Morbidity
Received: 23 Jul 2025; Accepted: 30 Sep 2025.
Copyright: © 2025 He, Wang, Xu and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yang He, heyang1235@126.com
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