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Abstract
Purpose :
We evaluate respiratory morbidities in infants beyond 35 weeks of gestation born via elective cesarean section by gestational age.
Methods :
This is a retrospective study of 443 infants who were born at Seoul National University Hospital by elective cesarean section beyond 35 weeks of gestation from January 2011 to December 2012. We compared respiratory morbidities in four groups classified by gestational age (35+0-36+6 weeks, 37+0-37+6 weeks, 38+0-38+6 weeks, 39+0-40+6 weeks).
Results :
There were significantly lower Apgar scores in the late-preterm infant group (35-36 weeks) compared to other term infant groups and the proportion of infants born from mothers with preeclampsia gradually decreased as gestational age increased. There were significant differences in O2 supplement, duration of O2 (>24 hours), checked chest radiography, transient tachypnea of newborn (TTN), transfer to neonatal intensive care unit (NICU), endotracheal intubation, and ventilator uses including nasal continuous positive airway pressure in four groups (P<0.05). By logistic regression analysis, compared to births at 38 weeks, births at 35-36 weeks and at 37 weeks were associated with an increased risk of respiratory morbidities [odds ratios (OR) and 95% confidence intervals (CI) for births at 35-36 weeks, 122.5 (17.4-863.4) for TTN; 54.0 (10.1-289.4) for transfer to NICU; 99.5 (14.9-666.2) for ventilator apply; OR and 95% CI for births at 37 weeks, 8.8 (1.6-50.1) for TTN; 5.3 (1.1-24.7) for transfer to NICU; 8.4 (1.5-47.7) for ventilator apply; P<0.05]. There were no significant differences in respiratory morbidities between births at 38 weeks and births at 39-40 weeks.
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Fig. 1
History of previous cesarean section, fetal malpresentation, placenta previa, history of previous uterine surgery, and maternal request were the major causes of elective cesarean section. The most frequent cause of elective cesarean section was history of previous cesarean section. Abbreviation : C/S, cesarean section.
Fig. 2
The proportions of respiratory morbidities in infants delivered by elective cesarean section decreased as gestational age increased. Abbreviations : NICU, neonatal intensive care unit; TTN, transient tachypnea of newborn.
Table 1.
Demographic Characteristics of Infants with Elective Cesarean Section
| 35-36 weeks (N=19) | 37 weeks (N=74) | 38 weeks (N=282) | 39-40 weeks (N=68) | P-value | |
|---|---|---|---|---|---|
| Infants | |||||
| Gestational age (week) | 36.2±0.6 | 37.6±0.3∗ | 38.5±0.3∗† | 39.3±0.3∗†,‡ | 0.000 |
| Birth weight (g) | 2,550.0±482.8 | 3,011.5±431.2∗ | 3,205.2±362.6∗† | 3421.9±421.1∗†,‡ | 0.000 |
| Male sex | 9 (47.4%) | 38 (51.4%) | 140 (49.6%) | 39 (57.4%) | 0.703 |
| Small for gestational age | 3 (15.8%) | 8 (10.8%) | 15 (5.3%) | 5 (7.4%) | 0.162 |
| Apgar score, 1 min | 7.0±1.2 | 7.8±0.8∗ | 7.9±0.7∗ | 8.0±0.6∗ | 0.000 |
| Apgar score, 5 min | 8.3±1.0 | 8.9±0.4∗ | 9.0±0.3∗ | 9.0±0.3∗ | 0.000 |
| Mothers | |||||
| Maternal age (year) | 33.8±6.3 | 33.7±3.2 | 34.1±4.0 | 34.0±4.3 | 0.852 |
| Primipara | 7 (36.8%) | 20 (27.0%) | 106 (37.6%) | 23 (33.8%) | 0.399 |
| Number of previous C/S | 0.58±0.61 | 0.65±0.69 | 0.68±0.74 | 0.69±0.63 | 0.911 |
| Mode of anesthesia | |||||
| Spinal | 14 (73.7%) | 52 (70.3%) | 235 (83.3%)† | 61 (89.7%) | 0.013 |
| Epidural | 4 (21.1%) | 8 (10.8%) | 30 (10.6%) | 6 (8.8%) | 0.503 |
| General | 1 (5.3%) | 14 (18.9%) | 17 (6.0%)† | 1 (1.5%)† | 0.000 |
| Preeclampsia | 7 (36.8%) | 6 (8.1%)∗ | 3 (1.1%)∗† | 0 (0.0%)∗† | 0.000 |
| Gestational diabetes mellitus | 2 (10.5%) | 6 (8.1%) | 22 (7.8%) | 5 (7.4%) | 0.975 |
Table 2.
Comparison of Respiratory Morbidity by Gestational Age
| 35-36 weeks (N=19) | 37 weeks (N=74) | 38 weeks (N=282) | 39-40 weeks (N=68) | P-value | |
|---|---|---|---|---|---|
| O2 supplement | 10 (52.6%) | 17 (23.0%)∗ | 45 (16.0%)∗ | 9 (13.2%)∗ | 0.000 |
| Duration of O2 (>24 hours) | 7 (36.8%) | 4 (5.4%)∗ | 3 (1.1%)∗ † | 1 (1.5%)∗ | 0.000 |
| Checked chest radiography | 11 (57.9%) | 11 (14.9%)∗ | 18 (6.4%)∗ † | 6 (8.8%)∗ | 0.000 |
| TTN | 7 (36.8%) | 4 (5.4%)∗ | 2 (0.7%)∗ † | 0 (0.0%)∗ | 0.000 |
| Transfer to NICU | 7 (36.8%) | 4 (5.4%)∗ | 3 (1.1%)∗ † | 0 (0.0%)∗ | 0.000 |
| Endotracheal intubation | 4 (21.1%) | 3 (4.1%)∗ | 0 (0.0%)∗ † | 0 (0.0%)∗ | 0.000 |
| Ventilator (including nasal CPAP) | 7 (36.8%) | 4 (5.4%)∗ | 2 (0.7%)∗ † | 0 (0.0%)∗ | 0.000 |
| At admission | |||||
| Respiratory symptom∮ | 11 (57.9%) | 19 (25.7%)∗ | 79 (28.0%)∗ | 10 (14.7%)∗ ‡ | 0.002 |
| Chest retraction | 9 (47.4%) | 10 (13.5%)∗ | 29 (10.3%)∗ | 5 (7.4%)∗ | 0.000 |
| Nasal flaring | 8 (42.1%) | 17 (23.0%)∗ | 66 (23.4%) | 8 (11.8%)∗ ‡ | 0.031 |
| Moaning sound | 7 (36.8%) | 12 (16.2%)∗ | 16 (5.7%)∗ † | 1 (1.5%)∗ † | 0.000 |
| 5 hours after birth | |||||
| Respiratory symptom∮ | 7 (36.8%) | 6 (8.1%)∗ | 8 (2.8%)∗ † | 1 (1.5%)∗ | 0.000 |
| Chest retraction | 7 (36.8%) | 4 (5.4%)∗ | 6 (2.1%)∗ | 1 (1.5%)∗ | 0.000 |
| Nasal flaring | 4 (21.1%) | 3 (4.1%)∗ | 6 (2.1%)∗ | 0 (0.0%)∗ | 0.000 |
| Moaning sound | 4 (21.1%) | 4 (5.4%)∗ | 2 (0.7%)∗ † | 0 (0.0%)∗ | 0.000 |
Table 3.
Multivariate Logistic Regression Analysis of Respiratory Morbidity by Gestational Age
| Odds ratio∗ (95% Confidence interval) | ||||
|---|---|---|---|---|
| 35-36 weeks (N=19) | 37 weeks (N=74) | 38 weeks (N=282) | 39-40 weeks (N=68) | |
| O2 supplement | 8.3 (2.3-29.5) | 2.1 (0.8-5.2) | 1.3 (0.6-2.9) | Reference |
| Duration of O2 (>24 hours) | 49.7 (4.7-522.8) | 4.1 (0.4-37.9) | 0.7 (0.1-7.3) | Reference |
| Checked chest radiography | 19.6 (4.8-79.7) | 2.0 (0.7-5.7) | 0.7 (0.3-1.9) | Reference |
| TTN | 122.5 (17.4-863.4) | 8.8 (1.6-50.1) | Reference | NA† |
| Transfer to NICU | 54.0 (10.1-289.4) | 5.3 (1.1-24.7) | Reference | NA† |
| Endotracheal intubation | 9.9 (1.5-65.4) | Reference | NA† | NA† |
| Ventilator (including nasal CPAP) | 99.5 (14.9-666.2) | 8.4 (1.5-47.7) | Reference | NA† |
| At admission | ||||
| Respiratory symptom‡ | 7.8 (2.3-26.6) | 2.0 (0.9-4.9) | 2.4 (1.2-5.0) | Reference |
| Chest retraction | 10.9 (2.7-44.4) | 1.9 (0.6-6.1) | 1.6 (0.6-4.4) | Reference |
| Nasal flaring | 4.4 (1.2-16.0) | 2.2 (0.9-5.6) | 2.4 (1.1-5.3) | Reference |
| Moaning sound | 63.7 (6.3-641.5) | 16.1 (2.0-129.9) | 4.5 (0.6-34.6) | Reference |
| 5hours after birth | ||||
| Respiratory symptom‡ | 92.6 (8.0-1063.1) | 7.4 (0.8-64.9) | 2.0 (0.2-16.7) | Reference |
| Chest retraction | 86.3 (7.4-1007.8) | 4.7 (0.5-44.2) | 1.5 (0.2-12.7) | Reference |
| Nasal flaring | 14.6 (2.1-98.7) | 2.1 (0.5-9.2) | Reference | NA† |
| Moaning sound | 98.8 (9.7-1004.0) | 10.3 (1.8-59.8) | Reference | NA† |
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