Abstract
Delivery of the newborn occurs either vaginally or via caesarean section. It is not known whether the mode of delivery and exposure to labor affects early autonomic nervous system (ANS) function, as measured by heart rate variability (HRV), or cortical electroencephalogram (EEG) activity. The objective of the study was to determine if autonomic function in newborns differs by mode of delivery. Simultaneous recording of EEG and electrocardiogram were collected in low-risk term newborns at <72 hours of age to measure HRV, the asymmetry index, and EEG power. Newborns were compared by delivery type: vaginal delivery (VD), cesarean section (CS) after labor (L-CS), or elective CS (E-CS). Quantile Regression controlled for gestational age, postnatal age, and percent active states. One hundred and eighteen newborns were studied at 25.2 (11.4) hours of age. Sixty-two (52.5%) were born by VD, 22 by L-CS (18.6%), and 34 by E-CS (28.8%). HRV metrics didn’t differ by delivery mode. Asymmetry index was higher in L-CS compared to VD and E-CS (P = 0.03). On EEG, L-CS newborns showed lower relative gamma power compared to VD and E-CS (P = 0.005). The study found that overall ANS tone is not altered by mode of delivery in low-risk term newborns.
Highlights
As the low-risk fetus nears delivery at term gestational age, the autonomic nervous system (ANS) and its cerebral connections adapt to support the infant during transition to the extra-uterine environment
We hypothesized that infants with exposure to labor, either during vaginal delivery or caesarean section following a period of labor, would have higher autonomic tone and higher EEG power compared to infants delivered by elective caesarean section prior to the onset of labor
Newborns born by L-cesarean section (CS) and elective CS (E-CS) were studied at an older postnatal age in hours than those born by vaginal delivery (VD) (P = 0.0001)
Summary
As the low-risk fetus nears delivery at term gestational age, the autonomic nervous system (ANS) and its cerebral connections adapt to support the infant during transition to the extra-uterine environment. Sympathetic outflow from the brainstem and from higher brain centers surges[1] to support successful transition of the fetus to the newborn[2]. The stimulus for these changes begins during labor. Oxytocin stimulates lactation and supports maternal-infant bonding through integration with limbic pathways[4] These and other substances are potentially neuroactive, yet the effects of mode of delivery and exposure to labor on autonomic tone and cortical activity in the term newborn remains incompletely understood. We hypothesized that infants with exposure to labor, either during vaginal delivery or caesarean section following a period of labor, would have higher autonomic tone and higher EEG power compared to infants delivered by elective caesarean section prior to the onset of labor
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