Approach to infants born before gestational week 26: Method of delivery, complication risks and health of the preterm neonate

Background: The survival of the preterm neonate has increased because of the use of antenatal corticosteroids. Accordingly, the gestational age limit of neonatal survival is lowered. Several reports show improved survival of extreme preterm neonates, though with relatively high rates of moderate and severe disability compared to those born at a gestational age above 24 weeks. The method of delivery has been claimed to be important for the survival of the extreme preterm neonate. The frequency of maternal complications is increased by caesarean section compared to vaginal delivery. The number of complications is related to gestational age. In the period 2005-2014 40 % of the neonates admitted to the Neonatal Intensive Care Unit (NICU) at Oslo University Hospital, Rikshospitalet, were born before gestational week 26, and 50 % of those born in week 24 and 25. Objective: The aim of this study was to give a literature review on complication rates following caesarean section with specific emphasis on the relation to gestational age at delivery and on survival and future health prospective of preterm neonates with specific focus on extreme prematurity. Secondly, to examine the method of delivery for the neonates born before gestational week 26.0 admitted to the NICU at Oslo University Hospital, Rikshospitalet with specific focus on the indication for caesarean section. Methods: Literature search was made in UpToDate and PubMed. The material for the selected 99 patients in the time period 2005-2010 was collected from Neonatalprogrammet at the NICU, Rikshospitalet. The information from NNK was further used to look at the mother´s medical record in DIPS. Conclusion: Complications occur in 1 out of 5 women with CD. The proportion is higher in emergency than elective CD, and the risk is higher if the procedure is performed late compared to early in the delivery process. Low gestational age has previously been shown to be a risk factor for complications, and complication rates as high as 45% has been reported in CD performed before gestational age 28. Frequent complications following preterm birth include respiratory distress syndrome, intra cranial hemorrhage, bronchopulmonary dysplasia and retinopathy of prematurity. The more immature the infant is at birth, the more frequent these complications occurs and the more serious they are. Lifelong sequelae may in some cases be the result from these complications. The prognosis for premature neonates has improved over the recent 20 years. The mortality among extreme premature neonates has decreased dramatically during the last 20-25 years. A survival rate of 20-30 % was reported for these neonates in the 1980s. Today this number has increased to 60%. According to our examination of nenonates born before week 26, there were performed C-section in 37 of 99 pregnancies, 94,5 % were unplanned. Indications for C-section were mostly fetal with breech position as the main indication