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 influence s 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 wi th a higher rate of respiratory distress syndrome compared with prolonged r upture of membranes, after controlling for gestational age, antenatal corti costeroid therapy, antenatal antibiotic administration, mode of delivery an d origin (inborn or outborn) (adjusted OR 3.12; 95% CI 1.55-6.28). The prev alence 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 grow th retardation/ pre-eclampsia, the rate of severe intraventricular haemorrh age was 3.2% and the rate of periventricular leukomalacia was 0.9%. Compare d with intrauterine infection and after controlling for potential confoundi ng covariates, intrauterine growth retardation/pre-eclampsia was associated with a lower rate of periventricular leukomalacia (adjusted OR 0.08; 95% C I 0.02-0.41). In the same multiple logistic regression model, antenatal cor ticosteroid administration was associated with a lower incidence of periven tricular leukomalacia (adjusted OK 0.36; 95% CI 0.16-0.79). Conclusions The cause of very preterm delivery has an important influence o n neonatal outcome.