Risk factors of neonatal respiratory distress following vaginal delivery and caesarean section in the German population.
BACKGROUND
The incidence of caesarean section (CS) is steadily rising world-wide. In particular, CS on maternal demand is performed more frequently. In parts, this might be due to insufficient information of pregnant women about neonatal risks of CS. We sought to specify neonatal outcomes following different modes of delivery, i.e. vaginal delivery, primary CS and secondary CS and to define risk factors for respiratory morbidity and hospitalization.


METHODS
We analysed 2073 births (gestational age > 35 weeks) during a two-year period at a tertiary obstetric and neonatal centre in Germany. Statistical analyses were performed for single parameters by SPSS as well as by logistic regression to account for possible confounders. Furthermore, extensive model calculation was done.


RESULTS
Respiratory morbidity was increased following primary and secondary CS (p = 0.001). By multiple logistic regression, the strongest effect on respiratory symptoms was seen with gestational age, each week more in utero reducing the risk by an odds ratio (OR) of 0.69 (95% CI: [0.61; 0.79]; p = 1.9 x 10(-8)). Furthermore, a significant interaction between mode of delivery and gestational age was found for the risk of respiratory symptoms (p = 0.0035).


CONCLUSIONS
For every eight newborns delivered by primary CS one more than expected with vaginal delivery is hospitalized. It is highly relevant to recognize that each week of gestational age reduces the risk of respiratory symptoms, especially if primary CS is performed. The higher rate of respiratory morbidity and neonatal admission following CS should be clearly recognized in counselling of pregnant women.
Heinzmann
Andrea
A
Centre for Pediatrics and Adolescent Medicine, University of Freiburg, Mathildenstrasse 1, Freiburg, Germany. andrea.heinzmann@uniklinik-freiburg.de
Brugger
Markus
M
Engels
Christina
C
Prömpeler
Heinrich
H
Superti-Furga
Andrea
A
Strauch
Konstantin
K
Krueger
Marcus
M
D002585:Cesarean Section / Q000009:adverse effects*; D016001:Confidence Intervals; D036861:Delivery, Obstetric / Q000009:adverse effects; D005260:Female; D005858:Germany / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011654:Pulmonary Edema / Q000453:epidemiology / Q000209:etiology*; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors