Comparison of short-term neonatal hemodynamic and metabolic outcomes in preterm births by mode of delivery

Introduction: Preterm birth remains a significant public health challenge due to the high risk of complications involving immature cardiopulmonary, renal, and metabolic systems. Despite various interventions, the optimal mode of delivery for preterm infants—particularly in relation to cardiovascular and hemodynamic stability—remains controversial. This study aimed to compare short-term neonatal outcomes following vaginal and cesarean deliveries in preterm births, with a focus on common complications related to circulatory, respiratory, and metabolic functions. Methods: This cohort study was conducted at Afzalipour Hospital in Kerman, Iran, between 2010 and 2018. Pregnant women with preterm labor were included and categorized based on mode of delivery: vaginal (n=425) and cesarean section (n=330). Each group was stratified by gestational age (≤24, 25–27, 28–30, 31–33, and 34–36 weeks). Key neonatal outcomes—including respiratory distress syndrome (RDS), hyperbilirubinemia, patent ductus arteriosus (PDA), ventilator dependence, and NICU admission—were recorded and analysed using SPSS-20. Results: The incidence of RDS (52.5% vs. 43.3%, p=0.02), neonatal jaundice (24.4% vs. 17.3%, p=0.03), and ventilator dependence (20.2% vs. 11.2%, p=0.01) was significantly higher in neonates delivered by cesarean section. Among appropriate-for-gestational-age (AGA) infants, PDA was less frequent following vaginal delivery (5.9% vs. 11.2%, p=0.01). NICU admission was significantly higher for AGA infants delivered by cesarean at 28–30 weeks (p=0.04) and for large-for-gestational-age (LGA) infants above 34 weeks (p=0.04). Conclusion: The findings suggest that vaginal delivery in preterm births may lead to more favourable early neonatal outcomes, particularly in terms of respiratory function, hemodynamic stability, and metabolic adaptation. These results can contribute to improved clinical decision-making for high-risk pregnancies, with a focus on optimising cardiovascular and systemic outcomes in premature newborns.