The influence of timing of elective cesarean section on risk of neonatal pneumothorax.
OBJECTIVE
To determine whether the timing of elective cesarean delivery at term influences the risk of neonatal pneumothorax.


METHODS
Chart reviews confirmed gestational age, delivery modalities, and diagnosis of pneumothorax of 66,961 term infants delivered in the Veneto region of northern Italy. Of these neonates, 17,783 (26.5%) were delivered by cesarean section, including 9988 elective (56.1%) and 7795 emergency (43.8%).


RESULTS
In 5498 (55.0%) of neonates, an elective cesarean section was performed before 39 completed weeks. Fifty-nine neonates had pneumothorax diagnosed (0.88/1000 births). Neonates delivered by elective cesarean section had an increased incidence of pneumothorax (2.90/1000 births), in comparison with neonates delivered by emergency cesarean (1.53/1000 births; OR 4.21; 95% CI 2.02-8.74) or vaginally delivered (0.39/1000 births; OR 7.95; 95% CI 4.41-14.32). In elective cesarean sections there was a significant progressive reduction in the incidence of pneumothorax from week 37 0/7 to 37 6/7 onward (P < .01).


CONCLUSIONS
The timing of elective cesarean section influences the pneumothorax risk. A reduction in neonatal iatrogenic pneumothorax would result if elective deliveries were performed after the 39 completed weeks of pregnancy.
Zanardo
Vincenzo
V
Department of Pediatrics, Padua University School of Medicine, Padua, Italy. zanardo@pediatria.unipd.it
Padovani
Ezio
E
Pittini
Carla
C
Doglioni
Nicoletta
N
Ferrante
Anna
A
Trevisanuto
Daniele
D
D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D009321:Natural Childbirth; D016017:Odds Ratio; D011030:Pneumothorax / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D011175:Positive-Pressure Respiration; D011247:Pregnancy; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D013997:Time Factors