Vacuum extraction for the preterm newborn and the long-term neurological outcome

Objective
Concern exists with regards to a possible harmful impact of vacuum extraction on the preterm newborn. We aimed to evaluate the long-term pediatric neurodevelopmental outcome of the preterm offspring following vacuum extraction.

Study Design
A population based cohort analysis was performed comparing the risk for long-term neurological morbidity (up to the age of 18 years) of children born preterm (<37 completed weeks of gestation) following vacuum extraction as compared with those born via spontaneous vaginal delivery. Neurological morbidity included hospitalizations involving a pre-defined set of ICD-9 codes, as recorded in the hospital medical records. Deliveries occurred between the years 1991-2013 in a tertiary medical center. Term deliveries, multiple pregnancies, fetal congenital malformations, and any cesarean deliveries were excluded from the analysis. A Kaplan-Meier survival curve was constructed to compare cumulative neurological morbidity in both groups. A Cox proportional hazards model was used to control for confounders.

Results
During the study period 10,805 preterm newborns met the inclusion criteria; 97.5% (n=10,539) of which were born via spontaneous vaginal delivery and 2.5% (n=266) underwent a vacuum extraction. Neurological morbidity was comparable between the groups (Table) as was the cumulative incidence of total neurological morbidity using a Kaplan-Meier survival curve (Log rank p=0.931, Figure). In the Cox regression model, vacuum delivery in preterm newborns was not associated with increased pediatric neurological morbidity as compared with spontaneous vaginal delivery while controlling for gestational age, birth weight, and maternal age (adjusted HR 1.07, 95% CI 0.6-1.9, p=0.831).

Conclusion
Vacuum extraction in the preterm newborn does not appear to negatively impact on the long-term pediatric neurological morbidity.