title: Non-urgent caesarean delivery increases the need for ventilation at birth in term newborn infants.
abstract: OBJECTIVE
  To compare the need for positive pressure ventilation (PPV) by bag and mask and by bag and endotracheal tube in newly born term infants with vertex presentation delivered by non-urgent caesarean section under regional anaesthesia or non-instrumental vaginal delivery.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  35 public hospitals in 20 Brazilian state capitals.
  
  
  METHODS
  6929 inborn infants without congenital anomalies, with gestational ages from 37(0/7) to 41(6/7) weeks with vertex presentation, born between 1 and 30 September 2003.
  
  
  METHODS
  Non-urgent caesarean versus non-instrumental vaginal delivery. Non-urgent caesarean was defined as delivery occurring in the absence of prolapsed cord, third trimester haemorrhage, failure of labour induction, fetal distress or non-clear amniotic fluid.
  
  
  METHODS
  PPV with bag and mask and with bag and endotracheal tube. Both outcomes were adjusted for potential confounding variables by logistic regression analysis.
  
  
  RESULTS
  2087 infants were born by non-urgent caesarean and 4842 by non-instrumental vaginal delivery. Non-urgent caesarean delivery under regional anaesthesia compared to vaginal delivery under local or no anaesthesia increased the risk of bag and mask ventilation (OR 1.42, 95% CI 1.07 to 1.89) adjusted for number of gestations, maternal hypertension and birth weight. Ventilation with bag and endotracheal tube was associated only with low birth weight, adjusted for delivery mode and twin gestation.
  
  
  CONCLUSIONS
  Term neonates with vertex presentation and clear amniotic fluid born by non-urgent caesarean section under regional anaesthesia need to be assisted at birth by health professionals skilled in PPV.
authors.affiliation: Neonatal Division, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Maria Fernanda Branco
authors.initials: MF
authors.lastname: de Almeida
authors.forename: Ruth
authors.initials: R
authors.lastname: Guinsburg
authors.forename: José Orleans
authors.initials: JO
authors.lastname: da Costa
authors.forename: Lêni Márcia
authors.initials: LM
authors.lastname: Anchieta
authors.forename: Lincoln Marcelo Silveira
authors.initials: LM
authors.lastname: Freire
authors.forename: Dioclécio
authors.initials: D
authors.lastname: Campos
mesh_terms: D000293:Adolescent; D000328:Adult; D000765:Anesthesia, Conduction / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000379:methods; D001724:Birth Weight; D001938:Brazil; D002585:Cesarean Section; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000379:methods; D011175:Positive-Pressure Respiration / Q000379:methods / Q000706:statistics & numerical data*; D011247:Pregnancy; D055815:Young Adult