title: Cesarean deliveries and other risks for persistent pulmonary hypertension of the newborn.
abstract: OBJECTIVE
  To evaluate risks for persistent pulmonary hypertension in the newborn, confirmed by echocardiography, associated with cesarean deliveries and other factors.
  
  
  METHODS
  Cohort of all deliveries >36 weeks within a period of 23 months. A nested case-control study was performed in a subset of the cohort, involving newborns admitted into neonatal intensive care unit with diagnosis of persistent pulmonary hypertension matched with normal controls, with application of questionnaires to mothers to identify risks. Logistic regression was used to calculate odds ratios.
  
  
  RESULTS
  From 9452 newborns, 8388 (88.7%) were delivered by cesarean and 1064 (11.3%) by vaginal delivery. Questionnaires were applied to 173 mothers. Infants from cesareans had a fivefold increased risk of persistent pulmonary hypertension of the newborn: 42 (0.5%) versus 1 case (0.09%) in the vaginal group (OR 5.32, p=0.027). No interactions were found between smoking, parity, arterial hypertension and labor before cesarean section and persistent pulmonary hypertension of the newborn. First minute Apgar score <7 and maternal diabetes were related to increased risk.
  
  
  CONCLUSIONS
  Reducing cesarean deliveries could prevent many cases of serious persistent pulmonary hypertension of the newborn.
authors.affiliation: Unidade de Terapia Intensiva Neonatal, Hospital Santa Marina, São Paulo, SP, Brasil.
authors.forename: Orlei Ribeiro de
authors.initials: OR
authors.lastname: Araujo
authors.affiliation: Unidade de Terapia Intensiva Neonatal, Hospital Santa Marina, São Paulo, SP, Brasil.
authors.forename: Andréa de Cássia Stéfano
authors.initials: Ade C
authors.lastname: Albertoni
authors.affiliation: Unidade de Terapia Intensiva Neonatal, Hospital Santa Marina, São Paulo, SP, Brasil.
authors.forename: Vanessa Aparecida Aguiare
authors.initials: VA
authors.lastname: Lopes
authors.affiliation: Unidade de Terapia Intensiva Neonatal, Hospital Santa Marina, São Paulo, SP, Brasil.
authors.forename: Maria Eduarda Roses
authors.initials: ME
authors.lastname: Louzada
authors.affiliation: Unidade de Terapia Intensiva Neonatal, Hospital Santa Marina, São Paulo, SP, Brasil.
authors.forename: Alexandre Ordones
authors.initials: AO
authors.lastname: Lopes
authors.affiliation: Unidade de Terapia Intensiva Neonatal, Hospital Santa Marina, São Paulo, SP, Brasil.
authors.forename: Eloíza Aparecida Ferreira
authors.initials: EA
authors.lastname: Cabral
authors.affiliation: Unidade de Terapia Intensiva Neonatal, Hospital Santa Marina, São Paulo, SP, Brasil.
authors.forename: Marta Rodriguez
authors.initials: MR
authors.lastname: Afonso
authors.affiliation: Unidade de Terapia Intensiva Neonatal, Hospital Santa Marina.
authors.forename: Milena Corrêa
authors.initials: MC
authors.lastname: Araujo