Cesarean Delivery and Neonatal Intestinal Colonization

Abstract

Research Article| October 01 2016 Cesarean Delivery and Neonatal Intestinal Colonization AAP Grand Rounds (2016) 36 (4): 47. https://doi.org/10.1542/gr.36-4-47 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Cesarean Delivery and Neonatal Intestinal Colonization. AAP Grand Rounds October 2016; 36 (4): 47. https://doi.org/10.1542/gr.36-4-47 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: cesarean section, intestines, microbial colonization, newborn Source: Stokholm J, Thorsen J, Chawer BL, et al. Cesarean section changes neonatal gut colonization. J Allergy Clin Immunol. 2016; 138(3): 881– 889.e2; doi: https://doi.org/10.1016/j.jaci.2016.01.028Google Scholar Investigators from multiple institutions in Denmark conducted a prospective study to identify the relationship between route of delivery and subsequent bacterial colonization of the gastrointestinal tract and the airway in the first 12 months of life. Study participants included mothers and infants who had been enrolled in the Copenhagen Prospective Studies on Asthma, a cohort study of pregnant Danish women and their offspring. For the study, delivery route was categorized as vaginal, emergency cesarean (failed trial of labor), or elective cesarean (membranes ruptured at delivery). Fecal samples were collected and cultured on study children at 1 week, 1 month, and 1 year of life; hypopharyngeal samples were collected at 1 week, 1 month, and 3 months of life. Demographic information collected included maternal age, household income, maternal asthma, maternal smoking during pregnancy, pregnancy complications, the use of intrapartum antibiotics, older children in the home, and duration of breastfeeding. Rates of positive fecal and airway cultures for individual bacteria were compared among children born vaginally or by cesarean delivery. Of the 700 children in the cohort, 549 (78%) were born vaginally, 85 (12%) by emergency cesarean, and 66 (9%) by elective cesarean. All mothers who had cesarean delivery received intrapartum antibiotics compared to 13% of those who delivered vaginally. Fecal and airway samples were obtained on over 90% of enrolled newborns at most time points. The investigators found that at 1 week of life, intestinal colonization with Citrobacter freundii, Clostridium species, Enterobacter cloacae, Enterococcus faecalis, Klebsiella species, and Staphylococcus aureus were significantly associated with cesarean delivery (for either reason), and colonization with E. coli was significantly associated with vaginal delivery. These associations declined over time and disappeared by 1 year of life. No associations were found between route of delivery and airway colonization. The authors conclude that neonates delivered by cesarean section show a pattern of bacterial colonization in the first week of life that differs from that of babies delivered vaginally. They speculate that these differences may play a role in the development of immunemediated disease, such as asthma and allergy, later in life. Dr. Springer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. There can be no doubt that while life-saving for some newborns with intrapartum obstetric complications, cesarean delivery is associated with higher incidence of postnatal complications for both mother1–3 and infant.2–5 In the United States, approximately 32% of all deliveries are via cesarean,2 although less than 15% are medically indicated.5 Recently, efforts have been undertaken to reduce the number of cesarean deliveries that are not medically indicated, both from a professional5 as well as economic perspective.6 The authors of the... You do not currently have access to this content.