Mode of delivery and antenatal steroids and their association with survival and severe intraventricular hemorrhage in very low birth weight infants

Objective:to determine whether cs delivery and receipt of antenatal steroids (ans) in vertex-presenting singletons with a gestational age (ga) between 24 and 30 weeks is associated with improved survival and improved severe intraventricular hemorrhage (sivh)-free survival.study design:multicenter cohort, retrospective analysis of prospectively collected data. vertex-presenting singletons newborns with ga 24 to 30 weeks, birth weight between 500 and 1500 g, without major congenital malformations, born between 2001 and 2011 at neocosur centers were included.results:four thousand three hundred and eighty-six infants fulfilled inclusion criteria: 45.8% were delivered vaginally and 54.2% by cesarean section (cs). newborns delivered vaginally received less ans, had lower ga, apgar scores and a lower incidence of survival and sivh-free survival (p<0.001). newborns with better survival were those with ans, independent of mode of delivery. at 24 to 25 weeks ga, increased survival and sivh-free survival were associated with ans and cs delivery, compared with those who received ans and delivered vaginally.conclusions:among vertex-presenting singletons with ga 24 to 30 weeks, better survival and ivh-free survival were associated with ans, independent of mode of delivery. in infants at 24 to 25 weeks gestation the combination of ans/cs was associated with improvement in both outcomes.