Original ArticleAssociation of Cesarean Delivery with Childhood Hospitalization for Infections Before 13 Years of Age
Section snippets
Methods
We conducted a retrospective longitudinal cohort study of 731 803 children born between 2006 and 2016 in hospitals of the province of Quebec, Canada. The cohort includes the majority of children in Quebec, as most deliveries occur in the hospital. We extracted birth discharge summaries and future childhood hospitalizations from the Maintenance and Use of Data for the Study of Hospital Clientele registry. Each discharge summary contains clinical and demographic information, validated using
Results
Among 731803 infants with 4654995 person-years of follow-up, 163466 (22%) were born by cesarean delivery and 72136 (10%) by operative vaginal delivery (Table II; available at www.jpeds.com). Cesarean delivery was more frequent in women with nulliparity, those with morbidity, and those aged ≥30 years. Operative vaginal delivery was more frequent in nulliparous women.
The incidence of any childhood infection hospitalization was higher for cesarean (41.8 per 1000 person-years) and operative vaginal
Discussion
In this study of 731 803 infants followed from birth up to age 13 years, cesarean delivery was associated with increased risks of hospitalization for infectious diseases compared with nonoperative vaginal delivery. Risks were elevated for otitis media, acute upper respiratory infection, pneumonia, infectious enteritis, and a range of other infections. Associations decreased with age, appearing most prominent before age 1 year and disappearing at around age 5 years; however, the same pattern of
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Funded by the Canadian Institutes of Health Research (PJT-162300, to N.A.) and the Fonds de recherche du Québec-Santé (34695, to N.A.). The study sponsors were not involved in the study design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the manuscript for publication. The authors declare no conflicts of interest.