The relationships between antenatal management, the cause of delivery and neonatal outcome in a large cohort of very preterm singleton infants

Objective To determine whether the cause of very preterm delivery influences neonatal outcome. Design A cohort study of 685 consecutive singletons born before 33 weeks of gestation. Methods Causes of birth and perinatal outcome variables were correlated for statistical significance by uni- and multi-variate analyses. Results Intrauterine growth retardation or pre-eclampsia were associated with a higher rate of respiratory distress syndrome compared with prolonged rupture of membranes, after controlling for gestational age, antenatal corticosteroid therapy, antenatal antibiotic administration, mode of delivery and origin (inborn or outborn) (adjusted OR 3.12; 95% CI 1.55-6.28). The prevalence of grade 3-4 intraventricular haemorrhage or cystic periventricular leukomalacia was 25% in newborn babies born after intrauterine infection or prolonged rupture of membranes. Among infants born after intrauterine growth retardation/ pre-eclampsia, the rate of severe intraventricular haemorrhage was 3.2% and the rate of periventricular leukomalacia was 0.9%. Compared with intrauterine infection and after controlling for potential confounding covariates, intrauterine growth retardation/pre-eclampsia was associated with a lower rate of periventricular leukomalacia (adjusted OR 0.08; 95% CI 0.02-0.41). In the same multiple logistic regression model, antenatal corticosteroid administration was associated with a lower incidence of periventricular leukomalacia (adjusted OK 0.36; 95% CI 0.16-0.79). Conclusions The cause of very preterm delivery has an important influence on neonatal outcome.