Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study

doi:10.1136/bmj.39405.539282.BE

BMJ 2008;336:85-87 (12 January), doi:10.1136/bmj.39405.539282.BE (published 11 December 2007)

Research

Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study

Anne Kirkeby Hansen, research fellow¹, Kirsten Wisborg, staff specialist², Niels Uldbjerg, professor³, Tine Brink Henriksen, associate professor²

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 caesareansections and neonatal respiratory morbidity and the importanceof timing of elective caesarean sections.

Design Cohort study with prospectively collected data from theAarhus birth cohort, Denmark.

Setting Obstetric department and neonatal department of a universityhospital in Denmark.

Participants All liveborn babies without malformations, withgestational ages between 37 and 41 weeks, and delivered between1 January 1998 and 31 December 2006 (34 458 babies).

Main outcome measures Respiratory morbidity (transitory tachypnoeaof the newborn, respiratory distress syndrome, persistent pulmonaryhypertension of the newborn) and serious respiratory morbidity(oxygen therapy for more than two days, nasal continuous positiveairway pressure, or need for mechanical ventilation).

Results 2687 infants were delivered by elective caesarean section.Compared with newborns intended for vaginal delivery, an increasedrisk of respiratory morbidity was found for infants deliveredby elective caesarean section at 37 weeks’ gestation (oddsratio 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 morbidityshowed the same pattern but with higher odds ratios: a fivefoldincrease was found at 37 weeks (5.0, 1.6 to16.0). These resultsremained essentially unchanged after exclusion of pregnanciescomplicated by diabetes, pre-eclampsia, and intrauterine growthretardation, or by breech presentation.

Conclusion Compared with newborns delivered vaginally or byemergency caesarean sections, those delivered by elective caesareansection around term have an increased risk of overall and seriousrespiratory morbidity. The relative risk increased with decreasinggestational age.

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