NEW YORK (Reuters Health) - Cesarean section seems to improve the survival of most infants delivered very prematurely (at 22 to 25 weeks of pregnancy, instead of 40 weeks) new research shows.

Using linked birth and infant death certificate files in the U.S. for 2000-2003, Dr. Michael H. Malloy, from the University of Texas Medical Branch in Galveston, examined the affect that c-section had on infant survival in the first 27 days of life of a group of infants born very preterm. Data from 13,733 deaths and 106,809 survivors were included in the analysis.

Compared with normal vaginal delivery, c-section improved survival of infants delivered at 22 to 25 weeks of pregnancy, Malloy found.

The odds of infant death for delivery at 22 weeks of pregnancy were 42 percent lower with c-section than with normal vaginal delivery.

For delivery at 23, 24, and 25 weeks of pregnancy, the odds of infant death were 48 percent, 28 percent, and 19 percent lower, respectively, with c-section than with vaginal delivery.

Moreover, these findings were independent of several risk factors indicating a need for cesarean section. More than 80 percent of the women that delivered from 22 to 31 weeks of pregnancy had at least one risk factor for cesarean delivery, including multiple birth, breech presentation, fetal defect, and medical or labor complication.

"Although the choice of cesarean section for the most immature of these infants may offer survival advantages," notes Malloy, "consideration of the neurodevelopmental risks associated with survival at this early age and consideration of the maternal costs of cesarean section also must be taken into account."

SOURCE: Pediatrics, August, 2008.

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