Is delivery mode associated with intraventricular haemorrhage in very preterm infants? A retrospective analysis using brain magnetic resonance performed at term-equivalent age

Objective. To evaluate the association between delivery mode and intraventricular haemorrhage (IVH) in very preterm infants.
Methods. We retrospectively reviewed 280 brain MRI scans routinely performed at term-equivalent age (TEA:39^+0/7-41^+6/7 weeks/days) in infants born between 24^+0/7 and 31^+6/7 week/days at “G. Salesi” Children’s Hospital, Ancona, Italy, from 01/01/2018 to 12/31/2023. Infants with malformations, delivery complications (e.g., placental abruption, cord prolapse, abnormal cardiotocographic tracing), no antenatal corticosteroids, or unavailable susceptibility-weighted imaging (SWI) were excluded. The primary outcome was IVH grades I-IV detected by SWI-sequences at TEA. The associations between delivery mode, caesarean section (CS) versus vaginal delivery (VD), and IVH were analysed using multiple regression.
Results. Of 159 eligible infants, 74% were born by CS. SWI-sequences identified 48 cases of IVH, 27 of which were undetected by routine cranial ultrasound. IVH incidence was lower in CS than VD infants (IVH grades I-IV: 24 vs 48%, p = 0.004; IVH grades I-II: 23 vs 41%, p = 0.031; IVH grades III-IV: 1 vs 7%, p = 0.026). CS was associated with a lower likelihood of IVH (aOR: 0.36, p = 0.026) after adjusting for GA, SGA^BW< 10° centile, hypertensive disorders of pregnancy, early-onset sepsis, hemodynamically significant patent ductus arteriosus, histological chorioamnionitis, need of mechanical ventilation and inotropes/vasoactive amines in the first week of life.
Conclusions. We provide novel information on the association between delivery mode and IVH in a selected population of uncomplicated deliveries. The incidence of IVH was significantly higher in CS vs VD. MRI-SWI sequences detected over twice as many IVH cases as cranial ultrasound.