Elective Caesareans Tied to Breathing Problems in Babies - article free online

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December 25, 2007

Birthing: Elective Caesareans Tied to Breathing Problems

By Bakalar

http://www.nytimes.com/2007/12/25/health/25baby.html

Babies delivered by elective Caesarean sections are significantly more

likely to have respiratory problems than those delivered vaginally or by

emergency surgery, a new study finds.

Researchers studied 34,458 successive live single births at a hospital

in Aarhus, Denmark; 2,687 were elective Caesareans. The study was

published online on Dec. 11 in The British Medical Journal.

The younger the gestational age, the more breathing problems there were

for all babies, and the authors emphasized that the risk was small for

all groups.

Still, the increased risk for the elective Caesarean babies was notable.

At 37 weeks, they were almost four times as likely as others of the same

gestational age to have respiratory problems, at 38 weeks three times as

likely, and at 39 weeks almost twice as likely.

The differences remained even after controlling for maternal age,

smoking, alcohol intake and other variables.

The reason is unclear. The researchers theorize that hormonal and

physiological changes in labor might help fetal lungs mature properly.

" We know that the earlier a baby is born, the more immature the lungs, "

said Dr. Anne Kirkeby Hansen, the lead author and a research fellow at

Aarhus University Hospital. " According to our study, it would be a good

idea to postpone elective Caesareans until 39 weeks, even though we know

that some women might go into spontaneous labor before that date. "

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http://www.bmj.com/cgi/content/abstract/bmj.39405.539282.BEv1

http://www.bmj.com/cgi/reprint/bmj.39405.539282.BEv1

Risk of respiratory morbidity in term infants delivered by

elective caesarean section: cohort study

*Anne Kirkeby Hansen*, /research fellow/^1 , *Kirsten Wisborg*, /staff

specialist/^2 , *Niels Uldbjerg*, /professor/^3 , *Tine Brink

Henriksen*, /associate professor/^2

^1 Perinatal Epidemiology Research Unit, Aarhus University Hospital,

Brendstrupgaardsvej 100, Skejby, 8200 Aarhus N, Denmark, ^2 Department

of Paediatrics, Aarhus University Hospital, ^3 Department of Obstetrics

and Gynaecology, Aarhus University Hospital

Correspondence to: A K Hansen AKH{at}svf.au.dk

*Objective* To investigate the association between elective caesarean^

sections and neonatal respiratory morbidity and the importance^ of

timing of elective caesarean sections.^

*Design* Cohort study with prospectively collected data from the^ Aarhus

birth cohort, Denmark.^

*Setting* Obstetric department and neonatal department of a university^

hospital in Denmark.^

*Participants* All liveborn babies without malformations, with^

gestational ages between 37 and 41 weeks, and delivered between^ 1

January 1998 and 31 December 2006 (34 458 babies).^

*Main outcome measures* Respiratory morbidity (transitory tachypnoea^ of

the newborn, respiratory distress syndrome, persistent pulmonary^

hypertension of the newborn) and serious respiratory morbidity^ (oxygen

therapy for more than two days, nasal continuous positive^ airway

pressure, or need for mechanical ventilation).^

*Results* 2687 infants were delivered by elective caesarean section.^

Compared with newborns intended for vaginal delivery, an increased^ risk

of respiratory morbidity was found for infants delivered^ by elective

caesarean section at 37 weeks' gestation (odds^ ratio 3.9, 95%

confidence interval 2.4 to 6.5), 38 weeks'^ gestation (3.0, 2.1 to 4.3),

and 39 weeks' gestation (1.9,^ 1.2 to 3.0). The increased risks of

serious respiratory morbidity^ showed the same pattern but with higher

odds ratios: a fivefold^ increase was found at 37 weeks (5.0, 1.6

to16.0). These results^ remained essentially unchanged after exclusion

of pregnancies^ complicated by diabetes, pre-eclampsia, and intrauterine

growth^ retardation, or by breech presentation.^

*Conclusion* Compared with newborns delivered vaginally or by^ emergency

caesarean sections, those delivered by elective caesarean^ section

around term have an increased risk of overall and serious^ respiratory

morbidity. The relative risk increased with decreasing^ gestational age.

*

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