Abstract
Background and Objectives: Extremely preterm infants (<28 weeks' gestation) face high risks of morbidity and mortality, and the optimal mode of delivery for this population is debated. This retrospective study evaluated the impact of delivery mode (vaginal vs. cesarean section) on neonatal outcomes in extremely preterm infants. Materials and Methods: Ninety-two singleton births at 22 + 0 to 25 + 6 weeks of gestation were analyzed. Primary endpoints were survival to discharge; intraventricular hemorrhage (IVH); necrotizing enterocolitis (NEC); and arterial umbilical cord pH. Secondary endpoints included APGAR scores; preterm premature rupture of membranes (PPROMs); and pathological vaginal microbial colonization. Results: Survival to discharge did not differ significantly between vaginal delivery (84.8%) and cesarean section (93.5%) (p = 0.140). No significant differences were observed for NEC, APGAR scores, or umbilical arterial cord pH. IVH occurred more often after vaginal birth (47.8% vs. 30.4%, p = 0.080). In multivariable analysis, male sex was significantly associated with adverse outcome (p = 0.041); while PPROM showed a borderline association (p = 0.079). Complete antenatal corticosteroid administration was more frequent in the cesarean group (p = 0.021) and represented a relevant confounder. Conclusions: Delivery mode had no significant effect on survival in this cohort, though IVH tended to occur more frequently after vaginal birth. Male sex and complete antenatal corticosteroid exposure were key determinants of neonatal outcome. Prospective studies are needed to establish evidence-based recommendations.