Cesarean section increases the risk of respiratory adaptive disorders in healthy late preterm and two groups of mature newborns

Abstract

The rates of delivery by Cesarean section (CS) have been trending upwards in recent decades, perhaps leading to higher rates of dysfunction in respiratory adaptation in newborns. We present epidemiological data for pulmonary adaptation by mode of delivery for healthy late preterm and term infants born at a regional tertiary care center. The overall CS rate was 22% with the largest proportion of these in late preterms (39%). This drops to 30% in infants born after 37 weeks gestation and to 11% for those born after 40 weeks. Infants needing respiratory support decreased significantly as gestational age increased: 88% at 34 weeks, 67% at 35 weeks, 28% at 36 weeks, 17% at 37 weeks and 8% at 40 weeks. The risk of respiratory morbidity following CS as compared to vaginal delivery (VD) was substantially higher. 50% of infants born by CS needed respiratory support compared to only 12% following VD. 82% of all late preterm infants born by CS developed respiratory morbidity compared to 36% following VD. Comparable data for infants born after 37 and 40 weeks gestation were 33% compared to 9% and 26% compared to 6% respectively. Late preterm infants born after 36 weeks gestation showed the most marked difference by mode of birth with 66% needing respiratory support following CS as compared to only 9% following VD. Our data could be useful in counselling parents about risk associated with delivery by Cesarean section. A critical view should be taken of increasing CS rates worldwide because of a clear correlation in increased morbidity in infants, especially late preterm infants.

Zusammenfassung

Die Kaiserschnittrate erhöhte sich in den letzten Jahrzehnten in zahlreichen geburtshilflichen Kliniken. Diese Entwicklung ist problematisch, weil damit eine erhöhte Morbidität der Neugeborenen verbunden ist.Die Arbeit untersucht die Anpassung von späten Frühgeborenen (34,0–36,6 SSW) und reifen Neugeborenen (37,0–37,6 und 40,6–40,6 SSW) in Abhängigkeit vom Geburtsmodus. Eingeschlossen wurden primär gesunde Kinder. Ausgeschlossen wurden Kinder mit angeborener Anomalie und Kinder mit einer schweren Anpassungsstörung (Apgar 5‘<6).Die Kaiserschnittrate lag bei 22% und war am höchsten bei späten Frühgeborenen (39%) im Vergleich zu Kindern der 37. (30%) und der 40. SSW (11%).Die Rate der Kinder, die mit CPAP behandelt werden mussten fiel von 88% in der 34. SSW auf 17% in der 37. und 8% in der 40. SSW. Kinder nach Kaiserschnitt mussten im Vergleich zur Spontangeburt häufiger mit CPAP therapiert werden (50 vs. 12%). Dieser Unterschied war für späte Frühgeborene deutlich (82 vs. 36%), mit einem Maximum in der 36. SSW (66 vs. 9%) und lag niedriger bei Kindern der 37. (33 vs. 9%) und 40. SSW (26 vs. 6%).Die Ergebnisse zeigen, dass ein Kaiserschnitt zu einer schlechteren respiratorischen Anpassung führt. Dies gilt für späte Frühgeborene aber auch für reife Kinder.Eine Kaiserschnittentbindung führt zu einer erhöhten Rate an respiratorischen Anpassungsstörungen, zur neonatologischen Aufnahme der Kinder, zu Störung der Mutter-Kind-Bindung, sowie zu einer finanziellen Belastung des Gesundheitssystems. Es ist zu wünschen, dass die Daten der Studie benutzt werden, um immer den besten Geburtsweg für das Kind zu finden.

Key words

Cesarean section - late preterm - RDS

Schlüsselwörter

Kaiserschnitt - späte Frühgeborene - Atemnotsyndrom

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