704 - The impact of the mode of delivery on the prevalence of necrotizing enterocolitis in newborn infants: a national cohort study

Publication Number: 704.6955

Leen I. I.. Sabbooba, Cleveland Clinic Children's, Fairview park, Cleveland, OH, United States; Mohsen A.A.. Farghaly, Cleveland Clinic Children's, Cleveland, OH, United States; Hatem Eltaly, Cleveland Clinic Children's, Cleveland, OH, United States; Aysuna Galandarova, Cleveland Clinic, Cleveland, OH, United States; Hany Aly, Cleveland Children’s Hospital, Cleveland, OH, United States; Mohamed A. Mohamed, Cleveland Clinic Children's, Cleveland, OH, United States

Background: There have been conflicting reports that associate the mode of delivery with neonatal infections. While some claim the association of vaginal delivery (VD) with exposure to floral colonization and severe infections. Others reports, in small sample size, the association of Cesarean deliveries (CD) with necrotizing enterocolitis (NEC) in newborn infants.

Objective: To explore the association of CD with the prevalence of necrotizing enterocolitis in term and preterm infants < 1500g birth weight (BW) and to examine potential predisposing factors and other adverse outcomes.

Design/Methods: This cohort used the national dataset produced by the Healthcare Cost and Utilization Project (HCUP) from 2016 to 2020. We used the International Classification of Diseases-Version 10 (ICD10) codes to extract variables. We used Chi square and Fisher exact test to examine odds ratios (OR) of relevant associations and logistic regression models to control for confounding factors.

Results: This study included 18,973,800 newborn infants who were born in the hospital system report to HCUP. Of them, 5,957,778 (32.9%) delivered CD and 33,763 (0.18%) developed NEC. The prevalence of NEC among infants delivered via CD was 14,217(0.24%) vs. 7089 (0.06%) in infants delivered via VD, adjusted odds ratios aOR 1.24 (1.20-1.28), < 0.001. We further examined infants more than or less than 1500g separately. Among infants > 1500g BW, the prevalence of NEC among infants delivered via CD was 5135(0.09%) vs. 3719(0.03%) in infants delivered vaginally, aOR 1.24 (1.18-1.29), < 0.001. While, in infants < 1500g BW, the prevalence of NEC in infants delivered via CD was 9082(5.94%) vs. 3371(4.99%), aOR 1.16 (1.11-1.21), < 0.001. Female sex was the only factor associated with less incidence of NEC, aOR 0.84 (0.80-0.88), < 0.001. Meanwhile, GA < 34 week, BW < 1500g, congenital heart disease, congenital diaphragmatic hernia, abdominal wall defect, multiple congenital anomalies and chromosomal disorders, maternal hypertension, maternal diabetes, chorioamnionitis, respiratory distress syndrome, anemia, blood stream infections, pulmonary hemorrhage, or pulmonary hypertension have all been statically associated with NEC.

Conclusion(s): Infant delivered via Cesarean deliveries have almost 25% increase odds to develop NEC during their neonatal hospital course. This ratio drops to about 16% in infants < 1500g BW but remains statistically associated with increased risk of NEC. Further studies are warranted to explore the causal relation between mode of delivery and adverse outcome such as NEC.