The delivery route for very-low-birth-weight infants. A preliminary report of a randomized, prospective study

Abstract

A major problem facing the perinatal team remains the care of the very-low-birth-weight infant (less than 1,500 gm), which includes not only the neonatal aspects but also the specific management aspects of labor and delivery. Numerous retrospective studies have suggested the potential benefits of cesarean delivery in the very-low-birth-weight group. In order to specifically address the question of the delivery route and its impact on neonatal outcome, a randomized, prospective study was designed. The study design specifically attempted to exclude the usual clinical estimation of fetal weight and sought to rely on other factors, which included the clinical availability of ultrasound as utilized by the physician staff. As the study proceeded, it became apparent on numerous occasions that the birth weights of infants who had been entered into this study were, in fact, in excess of the targeted weight range of 750-1,500 gm. In one instance an infant weighed in excess of 3,000 gm, and these observations led to a temporary discontinuation of the study. Data evaluation was undertaken from the first 40 patients entered into the study. This limited comparison failed to demonstrate significant differences regarding measures chosen to evaluate neonatal condition. It did define the limitations of correctly choosing infants for inclusion in this study. It is clear that more precise selection criteria must be available before the study of the effects of delivery route on outcome can be resumed appropriately.