Neonatal and Neurodevelopmental Outcomes Following Category 1 Cesarean Section in a Japanese Tertiary Perinatal Center

Abstract

Aim

To elucidate the neonatal and neurodevelopmental outcomes of infants born via Category 1 cesarean section (CS) in a Japanese tertiary perinatal center.

Methods

Infants born via Category 1 CS from 2015 to 2019 at the National Center for Child Health and Development were included. Neonatal outcomes, including intrapartum/infant death, cord blood pH, and Apgar scores, and neurodevelopmental outcomes assessed using the Kinder Infant Development Scale (KIDS) were examined.

Results

A total of 101 children from 95 mothers were evaluated. The median decision-to-delivery interval (DDI) was 16 min. No intrapartum deaths occurred. Three children died during the neonatal period, whereas one died at 5 years of age. Among those who died, two had congenital diaphragmatic hernia, whereas two were preterm. The mean cord blood pH was 7.22; the median Apgar scores were 8 and 9, at 1 and 5 min, respectively. Among the 97 children aged 1 year 9 months to 6 years 5 months who received the KIDS questionnaire, 74 (76%) responded, with a median developmental quotient (DQ) of 110. Two children had a DQ below 70, one of whom had trisomy 21. Poor outcomes, including death and DQ below 70, appeared associated with severe congenital diseases or preterm birth.

Conclusions

In this single-center cohort from a Japanese tertiary perinatal center operating in accordance with national guidelines and established emergency protocols, neonatal and neurodevelopmental outcomes were generally favorable among full-term infants without severe congenital disease who underwent Category 1 CS. Poor outcomes appeared to be related to fetal conditions including prematurity or anomalies.