{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T19:45:20Z","timestamp":1793303120971,"version":"4.5.0"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2019,4,22]],"date-time":"2019-04-22T00:00:00Z","timestamp":1555891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,13]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Evidence is lacking regarding the benefit of caesarean section (CS) for long-term neurodevelopmental outcomes in singleton preterm neonates. Therefore, uncertainty remains regarding obstetrical best practice in the delivery of premature neonates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>Our objective was to determine the association between the mode of delivery and neurodevelopmental outcomes in preterm singleton neonates who were delivered by vaginal route (VR), CS with labour (CS-L), or CS without labour (CS-NL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Singleton neonates of less than 29 weeks\u2019 gestation born January 1995 through December 2010 and admitted to our NICU and then assessed at neonatal follow-up clinic were studied. The primary outcome was neurodevelopmental impairment (NDI) defined as cerebral palsy, cognitive delay, major or minor visual impairment, or hearing impairment or deafness at 36 months\u2019 corrected age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In this retrospective cohort study of 1,452 neonates, 1,000 were eligible for the study and 881 (88.1%) were available for follow-up. There was no significant difference in mortality between VR group, CS-L group, and CS-NL group. At 3 years, there was no significant difference between the three groups in terms of NDI. The odds of composite outcome of mortality or NDI for neonates born via CS-NL versus VR, and CS\u2013L versus VR were 0.90 (95% confidence interval [CI]: 0.59 to 1.37) and 1.08 (95% CI: 0.72 to 1.61), respectively. Propensity score-based matched-pair analyses did not show a significant association between the composite outcome and CS with or without labour.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CS was not associated with increased survival or decreased risk of NDI in premature singleton neonates born at less than 29 weeks\u2019 gestation.<\/jats:p><\/jats:sec>","DOI":"10.1093\/pch\/pxz051","type":"journal-article","created":{"date-parts":[[2019,4,22]],"date-time":"2019-04-22T13:53:06Z","timestamp":1555941186000},"page":"93-101","source":"Crossref","is-referenced-by-count":4,"title":["Caesarean section and neonatal survival and neurodevelopmental impairments in preterm singleton neonates"],"prefix":"10.1093","volume":"25","author":[{"given":"Abhay","family":"Lodha","sequence":"first","affiliation":[{"name":"Cumming School of Medicine, University of Calgary, Calgary, Alberta"},{"name":"Alberta Health Services, Calgary, Alberta"},{"name":"Department of Pediatrics, Foothills Medical Center, Calgary, Alberta"},{"name":"Department of Community Health Sciences, University of Calgary, Calgary, Alberta"},{"name":"Alberta Children\u2019s Hospital Research Institute, University of Calgary, Calgary, Alberta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krystyna","family":"Ediger","sequence":"additional","affiliation":[{"name":"Cumming School of Medicine, University of Calgary, Calgary, Alberta"},{"name":"Alberta Health Services, Calgary, Alberta"},{"name":"Department of Pediatrics, Foothills Medical Center, Calgary, Alberta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dianne","family":"Creighton","sequence":"additional","affiliation":[{"name":"Alberta Health Services, Calgary, Alberta"},{"name":"Department of Pediatrics, Foothills Medical Center, Calgary, Alberta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selphee","family":"Tang","sequence":"additional","affiliation":[{"name":"Alberta Health Services, Calgary, Alberta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arijit","family":"Lodha","sequence":"additional","affiliation":[{"name":"Faculty of Kinesiology, University of Calgary, Calgary, Alberta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Wood","sequence":"additional","affiliation":[{"name":"Cumming School of Medicine, University of Calgary, Calgary, Alberta"},{"name":"Alberta Health Services, Calgary, Alberta"},{"name":"Department of Community Health Sciences, University of Calgary, Calgary, Alberta"},{"name":"Department of Obstetrics & Gynaecology, Foothills Medical Center, Calgary, University of Calgary, Calgary, Alberta"},{"name":"O\u2019 Brien Institute for Public Health, University of Calgary, Calgary, Alberta"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,4,22]]},"reference":[{"issue":"10","key":"2020120806433405600_CIT0001","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1001\/jama.2015.10244","article-title":"Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012","volume":"314","author":"Stoll","year":"2015","journal-title":"JAMA"},{"issue":"12","key":"2020120806433405600_CIT0002","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.3109\/14767051003678259","article-title":"Mode of delivery in the preterm gestation and maternal and neonatal outcome","volume":"23","author":"Ghi","year":"2010","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"12","key":"2020120806433405600_CIT0003","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1016\/j.earlhumdev.2012.09.006","article-title":"The long-term effects of birth by caesarean section: The case for a randomised controlled trial","volume":"88","author":"Hyde","year":"2012","journal-title":"Early Hum Dev"},{"issue":"1","key":"2020120806433405600_CIT0004","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/AOG.0b013e3182749ac9","article-title":"Mode of delivery at term and adverse neonatal outcomes","volume":"121","author":"Walsh","year":"2013","journal-title":"Obstet Gynecol"},{"key":"2020120806433405600_CIT0005","doi-asserted-by":"crossref","first-page":"95","DOI":"10.11606\/S1518-8787.2018052000742","article-title":"The influence of mode of delivery on neonatal and maternal short and long-term outcomes","volume":"52","author":"Prado","year":"2018","journal-title":"Rev Saude Publica"},{"issue":"6","key":"2020120806433405600_CIT0006","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1016\/j.ajog.2006.05.005","article-title":"Planned cesarean versus planned vaginal delivery at term: comparison of newborn infant outcomes","volume":"195","author":"Kol\u00e5s","year":"2006","journal-title":"Am J Obstet Gynecol"},{"issue":"6","key":"2020120806433405600_CIT0007","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1053\/j.semperi.2013.06.026","article-title":"Mode of delivery for periviable birth","volume":"37","author":"Mercer","year":"2013","journal-title":"Semin Perinatol"},{"issue":"4","key":"2020120806433405600_CIT0008","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1055\/s-2003-40608","article-title":"Vaginal delivery and neonatal outcome in extremely-low-birth-weight infants below 26 weeks of gestational age","volume":"20","author":"Bauer","year":"2003","journal-title":"Am J Perinatol"},{"issue":"3","key":"2020120806433405600_CIT0009","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1097\/01.AOG.0000154156.51578.50","article-title":"The impact of vaginal delivery in premature infants weighing less than 1,251 grams","volume":"105","author":"Deulofeut","year":"2005","journal-title":"Obstet Gynecol"},{"issue":"6","key":"2020120806433405600_CIT0010","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1111\/1471-0528.14938","article-title":"What is the safest mode of birth for extremely preterm breech singleton infants who are actively resuscitated? A systematic review and meta-analyses","volume":"125","author":"Grabovac","year":"2018","journal-title":"BJOG"},{"key":"2020120806433405600_CIT0011","doi-asserted-by":"crossref","DOI":"10.1007\/s00508-016-1150-2","article-title":"Effect of delivery mode on neonatal outcome among preterm infants: an observational study","author":"Holzer","year":"2017","journal-title":"Wien Klin Wochenschr"},{"issue":"1","key":"2020120806433405600_CIT0012","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.ejogrb.2006.07.049","article-title":"Influence of mode of delivery on neonatal mortality and morbidity in spontaneous preterm breech delivery","volume":"133","author":"Herbst","year":"2007","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"3","key":"2020120806433405600_CIT0013","first-page":"63","article-title":"Effects of mode of delivery on mortality and severe brain injury in extremely low birth weight infants in Arkansas","volume":"104","author":"Barber","year":"2007","journal-title":"J Ark Med Soc"},{"issue":"4","key":"2020120806433405600_CIT0014","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1080\/jmf.13.4.224.229","article-title":"Periventricular leukomalacia and mode of delivery in twins under 1500 g","volume":"13","author":"Salomon","year":"2003","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2020120806433405600_CIT0015","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejogrb.2013.10.017","article-title":"Vaginal delivery versus caesarean section in preterm breech delivery: a systematic review","volume":"172","author":"Bergenhenegouwen","year":"2014","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"5 Pt 1","key":"2020120806433405600_CIT0016","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/S0022-3476(05)81915-8","article-title":"Risk factors for early intraventricular hemorrhage in low birth weight infants","volume":"121","author":"Ment","year":"1992","journal-title":"J Pediatr"},{"issue":"2","key":"2020120806433405600_CIT0017","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1067\/S0002-9378(03)00360-0","article-title":"Does labor influence neonatal and neurodevelopmental outcomes of extremely-low-birth-weight infants who are born by cesarean delivery?","volume":"189","author":"Wadhawan","year":"2003","journal-title":"Am J Obstet Gynecol"},{"key":"2020120806433405600_CIT0018","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.ejogrb.2017.03.032","article-title":"Delivery mode and intraventricular hemorrhage risk in very-low-birth-weight infants: observational data of the German neonatal network","volume":"212","author":"Humberg","year":"2017","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"8988","key":"2020120806433405600_CIT0019","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1016\/S0140-6736(95)92471-X","article-title":"Case-control study of antenatal and intrapartum risk factors for cerebral palsy in very preterm singleton babies","volume":"346","author":"Murphy","year":"1995","journal-title":"Lancet"},{"issue":"9","key":"2020120806433405600_CIT0020","first-page":"CD000078","article-title":"Caesarean section versus vaginal delivery for preterm birth in singletons","author":"Alfirevic","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2020120806433405600_CIT0021","doi-asserted-by":"crossref","first-page":"186560","DOI":"10.1155\/2011\/186560","article-title":"Review of the recent literature on the mode of delivery for singleton vertex preterm babies","volume":"2011","author":"Ray Chaudhuri Bhatta","year":"2011","journal-title":"J Pregnancy"},{"issue":"6","key":"2020120806433405600_CIT0022","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1001\/jama.289.6.752","article-title":"Cognitive function in preterm infants: No simple answers","volume":"289","author":"Aylward","year":"2003","journal-title":"JAMA"},{"issue":"2","key":"2020120806433405600_CIT0023","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1542\/peds.2005-0173","article-title":"Poor predictive validity of the Bayley scales of infant development for cognitive function of extremely low birth weight children at school age","volume":"116","author":"Hack","year":"2005","journal-title":"Pediatrics"},{"issue":"10","key":"2020120806433405600_CIT0024","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1136\/adc.2009.160283","article-title":"The stability of the diagnosis of developmental disability between ages 2 and 8 in a geographic cohort of very preterm children born in 1997","volume":"95","author":"Roberts","year":"2010","journal-title":"Arch Dis Child"},{"issue":"3","key":"2020120806433405600_CIT0025","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.pediatrneurol.2008.09.017","article-title":"Outcomes for the extremely premature infant: What is new? And where are we going?","volume":"40","author":"Robertson","year":"2009","journal-title":"Pediatr Neurol"},{"issue":"1","key":"2020120806433405600_CIT0026","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1056\/NEJMoa041367","article-title":"Neurologic and developmental disability at six years of age after extremely preterm birth","volume":"352","author":"Marlow","year":"2005","journal-title":"N Engl J Med"},{"issue":"3","key":"2020120806433405600_CIT0027","doi-asserted-by":"crossref","first-page":"F235","DOI":"10.1136\/archdischild-2016-311228","article-title":"Determinants of developmental outcomes in a very preterm Canadian cohort","volume":"102","author":"Synnes","year":"2017","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"2","key":"2020120806433405600_CIT0028","first-page":"65","article-title":"Cerebral palsy","volume":"19","author":"Russman","year":"1989","journal-title":"Curr Probl Pediatr"},{"key":"2020120806433405600_CIT0029","author":"CNN Abstractor\u2019s Manual v.3.0.0","year":"2017"},{"key":"2020120806433405600_CIT0030","article-title":"Internal audit of the Canadian neonatal network data collection system","author":"Shah","year":"2017","journal-title":"Am J Perinatol"},{"issue":"4","key":"2020120806433405600_CIT0031","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/S0022-3476(78)80282-0","article-title":"Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1,500 gm","volume":"92","author":"Papile","year":"1978","journal-title":"J Pediatr"},{"issue":"4","key":"2020120806433405600_CIT0032","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1542\/peds.82.4.527","article-title":"Abnormal pulmonary outcomes in premature infants: Prediction from oxygen requirement in the neonatal period","volume":"82","author":"Shennan","year":"1988","journal-title":"Pediatrics"},{"issue":"1","key":"2020120806433405600_CIT0033","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1542\/peds.74.1.127","article-title":"An international classification of retinopathy of prematurity","volume":"74","year":"1984","journal-title":"Pediatrics"},{"issue":"1","key":"2020120806433405600_CIT0034","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00000658-197801000-00001","article-title":"Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging","volume":"187","author":"Bell","year":"1978","journal-title":"Ann Surg"},{"key":"2020120806433405600_CIT0035","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/1471-2431-13-59","article-title":"A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants","volume":"13","author":"Fenton","year":"2013","journal-title":"BMC Pediatr"},{"key":"2020120806433405600_CIT0036","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/1471-2431-13-92","article-title":"Validating the weight gain of preterm infants between the reference growth curve of the fetus and the term infant","volume":"13","author":"Fenton","year":"2013","journal-title":"BMC Pediatr"},{"issue":"4","key":"2020120806433405600_CIT0037","doi-asserted-by":"crossref","first-page":"578.e1","DOI":"10.1016\/j.ajog.2015.06.047","article-title":"Mode of delivery at periviability and early childhood neurodevelopment","volume":"213","author":"Obi\u010dan","year":"2015","journal-title":"Am J Obstet Gynecol"},{"issue":"3","key":"2020120806433405600_CIT0038","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/s12519-014-0497-6","article-title":"No relationship between mode of delivery and neonatal mortality and neurodevelopment in very low birth weight infants aged two years","volume":"10","author":"Zhu","year":"2014","journal-title":"World J Pediatr"},{"issue":"3","key":"2020120806433405600_CIT0039","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s00404-007-0438-x","article-title":"Caesarean or vaginal delivery for preterm very-low-birth weight (&lt; or =1,250 g) infant: Experience from a district general hospital in UK","volume":"277","author":"Haque","year":"2008","journal-title":"Arch Gynecol Obstet"},{"issue":"1","key":"2020120806433405600_CIT0040","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/AOG.0b013e318221001c","article-title":"Extremely preterm infant mortality rates and cesarean deliveries in the united states","volume":"118","author":"Batton","year":"2011","journal-title":"Obstet Gynecol"},{"issue":"2","key":"2020120806433405600_CIT0041","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1542\/peds.2007-2620","article-title":"Impact of cesarean section on neonatal mortality rates among very preterm infants in the United States, 2000-2003","volume":"122","author":"Malloy","year":"2008","journal-title":"Pediatrics"},{"issue":"1","key":"2020120806433405600_CIT0042","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1097\/01.AOG.0000192400.31757.a6","article-title":"Survival advantage associated with cesarean delivery in very low birth weight vertex neonates","volume":"107","author":"Lee","year":"2006","journal-title":"Obstet Gynecol"},{"issue":"12","key":"2020120806433405600_CIT0043","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1111\/j.1471-0528.2004.00268.x","article-title":"The relationship between delivery mode and mortality in very low birthweight singleton vertex-presenting infants","volume":"111","author":"Riskin","year":"2004","journal-title":"BJOG"},{"issue":"2","key":"2020120806433405600_CIT0044","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.ejogrb.2009.04.026","article-title":"Are active labour and mode of delivery still a challenge for extremely low birth weight infants? Experience at a tertiary care hospital","volume":"145","author":"Vimercati","year":"2009","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"2","key":"2020120806433405600_CIT0045","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1111\/ajo.12681","article-title":"Mode of delivery for singleton extreme preterm breech fetuses: A 10 year retrospective review from a single tertiary obstetric centre","volume":"58","author":"Hills","year":"2018","journal-title":"Aust N Z J Obstet Gynaecol"},{"issue":"1025","key":"2020120806433405600_CIT0046","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1136\/pgmj.2010.107532","article-title":"Neonatal outcomes of preterm infants in breech presentation according to mode of birth in canadian NICUs","volume":"87","author":"Lodha","year":"2011","journal-title":"Postgrad Med J"},{"key":"2020120806433405600_CIT0047","first-page":"8","article-title":"A report: The definition and classification of cerebral palsy April 2006","volume":"109","author":"Rosenbaum","year":"2007","journal-title":"Dev Med Child Neurol Suppl"},{"key":"2020120806433405600_CIT0048","article-title":"WHO. WHO recommendations on interventions to improve preterm birth outcomes. Geneva: World Health Organization; 2015."}],"container-title":["Paediatrics &amp; Child Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/pch\/article-pdf\/25\/2\/93\/34784427\/pxz051.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/pch\/article-pdf\/25\/2\/93\/34784427\/pxz051.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T13:52:46Z","timestamp":1663336366000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/pch\/article\/25\/2\/93\/5476249"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,22]]},"references-count":48,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,4,22]]},"published-print":{"date-parts":[[2020,3,13]]}},"URL":"https:\/\/doi.org\/10.1093\/pch\/pxz051","relation":{},"ISSN":["1205-7088","1918-1485"],"issn-type":[{"value":"1205-7088","type":"print"},{"value":"1918-1485","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,3]]},"published":{"date-parts":[[2019,4,22]]}}}