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Neonatal outcomes of preterm infants in breech presentation according to mode of birth in Canadian NICUs
  1. Abhay Lodha1,2,
  2. Qiaohao Zhu2,3,
  3. Shoo K Lee2,4,
  4. Prakesh S Shah2,4,
  5. the Canadian Neonatal Network
  1. 1Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
  2. 2Canadian Neonatal Network, Canada
  3. 3Department of Biostatistics, University of Alberta, Edmonton, Canada
  4. 4Department of Paediatrics, University of Toronto, Toronto, Canada
  1. Correspondence to Dr Abhay Lodha, Assistant Professor, Department of Pediatrics, University of Calgary, Staff Neonatologist and Clinical Epidemiologist, Foothills Medical Centre, Rm C211, 1403-29th St NW, Calgary, AB, Canada T2N2T9; abhay.lodha{at}


Background Many medical practitioners have adopted the practice of caesarean section for preterm infants in breech presentation based on term infant data. Some studies have highlighted deleterious effects on survival, such as intraventricular haemorrhage and periventricular leucomalacia, while others have reported no difference from the outcomes after vaginal delivery.

Objective To compare outcomes of preterm infants of ≤32 weeks' gestational age who were in breech position at the time of birth according to mode of birth in Canadian neonatal intensive care units (NICUs).

Settings 29 Canadian NICUs.

Design Neonates admitted to participating NICUs in the Canadian Neonatal Network between 2003 and 2007 were included in this retrospective study. Infants who were in breech position at the time of birth were divided into two groups: vaginal birth (VB) and caesarean section (CS). Data on common neonatal outcomes were compared using univariate and multivariate logistic regression.

Main outcome measures Neonatal mortality and other neonatal morbidities.

Results Of 3552 preterm infants in breech position at birth, 2937 (83%) were delivered by CS and 615 (17%) by VB. Multivariate regression analysis with adjustment for perinatal risk factors indicated that VB was associated with an increased risk of death (OR 1.7; 95% CI 1.3 to 2.3), chronic lung disease (OR 1.5; 95% CI 1.1 to 1.9) and severe retinopathy of prematurity (OR 1.6; 95% CI 1.1 to 2.3).

Conclusion Vaginal birth for preterm infants in breech presentation is possibly associated with a higher risk of adverse neonatal outcomes compared with caesarean birth in Canadian NICUs. It is not clear whether adverse outcomes are due to the mode of delivery or whether breech birth is associated with other risk factors, an issue that can only be resolved by a randomised controlled trial.

  • Infant
  • premature
  • breech
  • cesarean section
  • vaginal birth, epidemiology, neonatal intensive & critical care, neonatology

Statistics from


  • Presented at the Annual Meeting of the Pediatric Academic Societies, Baltimore, USA, 2–4 May 2009.

  • Site Investigators of the Canadian Neonatal Network: Shoo K Lee, (Director, Canadian Neonatal Network); Prakesh S Shah (Associate Director, Canadian Neonatal Network); Wayne Andrews (Janeway Children's Health and Rehabilitation Centre, St John's, NL); Keith Barrington (St Justine's Hospital, Montreal, QC); Wendy Yee (Foothills Medical Centre, Calgary, AB); Barbara Bullied (Everett Chalmers Hospital, Fredericton, NB); Rody Canning (Moncton Hospital, Moncton, NB); Gerarda Cronin (St Boniface General Hospital, Winnipeg, MB); Kimberly Dow (Kingston General Hospital, Kingston, ON); Michael Dunn (Sunnybrook Health Sciences Centre, Toronto, ON); Adele Harrison (Victoria General Hospital, Victoria, BC); Andrew James (Hospital for Sick Children, Toronto, ON); Zarin Kalapesi (Regina General Hospital, Regina, SK); Lajos Kovacs (Jewish General Hospital, Montreal, QC); Orlando da Silva (St Joseph's Health Centre; London, ON); Douglas D. McMillan (IWK Health Centre, Halifax, NS); Prakesh Shah (Mount Sinai Hospital, Toronto, ON); Cecil Ojah (St John Regional Hospital, St John, NB); Abraham Peliowski / Khalid Aziz (Royal Alexandra Hospital, Edmonton, AB); Bruno Piedboeuf (Centre Hospitalier Universitaire de Quebec, Sainte Foy, QC); Patricia Riley (Montreal Children's Hospital, Montreal, QC); Daniel Faucher (Royal Victoria Hospital, Montreal, QC); Nicole Rouvinez-Bouali (Children's Hospital of Eastern Ontario, Ottawa, ON); Koravangattu Sankaran (Royal University Hospital, Saskatoon, SK); Mary Seshia (Health Sciences Centre, Winnipeg, MB); Sandesh Shivananda (Hamilton Health Sciences Centre, Hamilton, ON); Zenon Cieslak (Royal Columbian Hospital, New Westminster, BC); Anne Synnes (Children's and Women's Health Centre of British Columbia, Vancouver, BC); Herve Walti (Centre Hospitalier Universitaire de Sherbrooke, Fleurimont, QC).

  • Funding Canadian Neonatal Network is supported by Maternal-Infant Care Research Center, Mount Sinai Hospital, Toronto. The Maternal-Infant Care Research Center is funded by the Ministry of Health and Long-Term Care, Ontario, Canada.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Calgary, Calgary, Canada.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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