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Association Between Mode of Delivery and Risk of Infection in Early Childhood: A Cohort Study

Christensen, Nikolas MD; Søndergaard, Jens MD, PhD; Christesen, Henrik Thybo MD, PhD; Fisker, Niels MD, PhD; Husby, Steffen MD, DMSc
The Pediatric Infectious Disease Journal: Post Acceptance: September 06, 2017
doi: 10.1097/INF.0000000000001778
Original Studies: PDF Only


Infections are the leading cause of morbidity and mortality in children. Caesarean section as a potential risk factor for infection has recently gained interest. Delivery by caesarean section has increased greatly with non-medical reasons playing an increasing role. We aimed to analyze the association between mode of delivery and hospitalizations due to infection and symptoms of infection at home in early childhood.


A cohort study, based on the Odense Child Cohort, following infants from gestation until a mean age of 3.5 years. Data on hospitalization due to infections were collected from the Danish National Patient Registry. Data on symptoms of infection at home were collected via a text message based questionnaire.


A total of 1,921 children were born by vaginal delivery, 283 by elective caesarean section and 227 by acute caesarean section. An adjusted regression model showed an incidence rate ratio for hospitalizations due to infection in children born by elective caesarean section compared with children born by vaginal delivery of 1.45 (95% CI = 1.16-1.80, p = 0.001). The analyses on symptoms of infection at home found no associations between any symptom of infection and mode of delivery. Symptom specific sub analyses showed contrasting results.


Mode of delivery showed a strong association to hospitalization due to infectious disease during early childhood. Overall, no association was present between rate of symptoms of infection at home and mode of delivery.

Conflicts of interest and source of funding: NC reports grants from Arla Foods Ingredients, grants from Hans Christian Andersen Children's Hospital, grants from Region of Southern Denmark, grants from The A.P. Møller Foundation, grants from The Strategic Research Council (Ref. No. 0603-00779B), during the conduct of the study; other authors report no conflicts of interest.

Disclosure of funding: No funding was received if not mentioned under Conflicts of interest and source of funding.

Acknowledgements: We thank the staff at Odense Child Cohort.

Contributors : NC, JS, HTC, NF and SH prepared the original protocol and overall design of the study. NC wrote the article in collaboration with SH, JS, HTC and NF. NC conducted data management and the statistical analyses. All authors have edited and approved the final draft.

Correspondence to: Nikolas Christensen, Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, DK-5000 Odense C, Denmark, Telephone number (+45) 51339174, Fax number (+45) 65911862,

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