Impact of Delivery Type and Prenatal Steroids in a Cohort of Premature Infants in Bosnia and Herzegovina

Background: Cohort studies are useful in determining how risk factors and outcomes differ among regions, populations and available resources. The aim of this five-year cohort study of premature infants from Bosnia and Herzegovina was to examine the impact of mode of delivery and administration of prenatal corticosteroids on key neonatal outcomes. Methods: This cohort study included 734 infants with gestational age 24 32 weeks, admitted to the neonatal intensive care unit of the Pediatric Hospital in Sarajevo from 1 Jan 2012 to 31 Dec 2016, including both inborn infants and infants transported from the smaller hospitals throughout the country. We also examined the subgroup of 225 infants with gestational age 24 28 weeks for the same outcomes. Results: In the full cohort, cesarean delivery was associated with a lower incidence of severe intraventricular hemorrhage (IVH) [6.5% (cesarean section, CS) vs. 13% (vaginal delivery) OR 0.45, 95% CI: 0.26 0.78 (p < 0.01)], but not with increased survival to discharge. Administration of prenatal corticosteroids was associated with decreased mortality [13% (yes) vs 21% (no) OR 0.53, 95% CI: 0.33 0.84 (p < 0.01)]. In the subgroup of extremely premature infants, CS was associated with a higher incidence of respiratory distress syndrome and surfactant administration, and prenatal steroid administration was associated with a lower mortality rate. Multiple regression analysis showed birth weight to be a significant predictor of survival to discharge and both birth weight and delivery type to be significant predictors of severe IVH. In this model, antenatal steroid administration was not a significant predictor of survival or severe IVH. Conclusion: In this cohort of premature infants born in Bosnia and Herzegovina, survival was not influenced by delivery type. In the full cohort, CS was associated with decreased risk of severe IVH but this association was not seen in the subgroup of more premature infants. We found an association between prenatal corticosteroids and decreased mortality, but this did not remain significant with multiple regression analysis.