title: Mode of delivery and neonatal respiratory morbidity among HIV-exposed newborns in Latin America and the Caribbean: NISDI Perinatal-LILAC Studies.
abstract: OBJECTIVE
  To evaluate respiratory morbidity (RM) in HIV-exposed newborns according to mode of delivery.
  
  
  METHODS
  The NISDI Perinatal/LILAC prospective cohort studies enrolled HIV-infected pregnant women and their newborns in Latin America and the Caribbean. Associations between RM and delivery mode or other characteristics were evaluated.
  
  
  RESULTS
  Between September 2002 and December 2009, 1630 women were enrolled, and 1443 mother-infant pairs met the inclusion criteria. There were 561 vaginal (VD), 269 cesarean before labor and membrane rupture (SCS) for preventing mother-to-child transmission (SCS-PMTCT), 248 other SCS, and 365 cesarean after labor and/or ruptured membranes (NSCS) deliveries. In total, 108 (7.5%) newborns had RM: 49 had respiratory distress syndrome (RDS), 39 had transient tachypnea (TTN), and 28 had other events (7 newborns had >1 RM event). Delivery mode was associated with RDS (P<0.005) and TTN (P<0.001). The proportion with RDS and TTN was lowest for VD (1.6% and 0.5%, respectively), highest for NSCS (4.9% and 4.7%), and intermediate for SCS-PMTCT (3.0% and 2.6%). Newborns with RDS or TTN were hospitalized longer (median +1day) than those without. A minority required ventilatory support (RDS, 24.5%-28.6%; TTN, 2.6%-15.4%).
  
  
  CONCLUSIONS
  SCS-PMTCT is relatively safe for newborns of HIV-infected women.
authors.affiliation: Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil. regis.kr@terra.com.br
authors.forename: Regis
authors.initials: R
authors.lastname: Kreitchmann
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Cohen
authors.forename: Sonia K
authors.initials: SK
authors.lastname: Stoszek
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Pinto
authors.forename: Marcelo
authors.initials: M
authors.lastname: Losso
authors.forename: Russell
authors.initials: R
authors.lastname: Pierre
authors.forename: Jorge
authors.initials: J
authors.lastname: Alarcon
authors.forename: Regina
authors.initials: R
authors.lastname: Succi
authors.forename: Edgardo
authors.initials: E
authors.lastname: Szyld
authors.forename: Thalita
authors.initials: T
authors.lastname: Abreu
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Read
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D017691:Caribbean Region / Q000453:epidemiology; D002585:Cesarean Section; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control / Q000706:statistics & numerical data; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology*; D012140:Respiratory Tract Diseases / Q000453:epidemiology*; D019562:Viral Load; D055815:Young Adult