Respiratory Morbidity In Neonates Research Articles

Development and Disorders of the Airway in Bronchopulmonary Dysplasia.

Bronchopulmonary dysplasia (BPD), a disorder characterized by arrested lung development, is a frequent cause of morbidity and mortality in premature infants. Parenchymal lung changes in BPD are relatively well-characterized and highly studied; however, there has been less emphasis placed on the role that airways disease plays in the pathophysiology of BPD. In preterm infants born between 22 and 32 weeks gestation, the conducting airways are fully formed but still immature and therefore susceptible to injury and further disruption of development. The arrest of maturation results in more compliant airways that are more susceptible to deformation and damage. Consequently, neonates with BPD are prone to developing airway pathology, particularly for patients who require intubation and positive-pressure ventilation. Airway pathology, which can be divided into large and small airways disease, results in increased respiratory morbidity in neonates with chronic lung disease of prematurity.

Respiratory Morbidity in Neonates at or Near-Term in Relation to Mode of Delivery - A Retrospective Observational Study

Introduction: Antenatal corticosteroids are recommended by Royal College of Obstetrics and Gynaecology for caesarean section planned before thirty-eight plus six weeks gestation. However, these steroids are, not suggested for labour induced electively after thirty four weeks.
 Objective: This study’s aim is to enumerate the possibility of respiratory morbidity in neonates for various deliberated approaches of delivery between thirty-five and thirty eight weeks gestation.
 Methodology: This study was carried out during June 2018 and December 2020 at a tertiary obstetric unit and analysed 3796 neonates delivered between thirty-five and thirty eight weeks gestation for neonatal admission due to respiratory morbidity.
 Results: The risk for respiratory problems in spontaneous labour was 9.9% (16/161), 5.0% (12/238), 1.2% (5/426) and 0.64% (6/930) at thirty five, thirty six, thirty seven and thirty eight weeks of gestation respectively. For induced labour, it was 25% (4/16), 4.8% (5/104), 4.1% (13/318) and 0.82% (4/485) at thirty-five, thirty six, thirty seven and thirty eight weeks respectively. While the risk of respiratory morbidity in elective caesarean section, was 13.8% (4/29), 27.1% (13/48), 4.1% (5/122) and 2.8% (9/318) at thirty-five, thirty six, thirty seven and thirty eight weeks respectively. Overall chance of respiratory morbidity in neonates was 6% after elective caesarean section, 2.8% after labour induction and 2.2% after spontaneous labour (p< 0.0001). The number of neonates with respiratory problems born by elective C-section was only 31 out of total 132 (23.5%). Whereas this risk was 2.8% at 35-38 weeks and 5.0% at 35-37 weeks after induced labour.
 Conclusion: Elective delivery at 35-38 weeks is linked to respiratory morbidity in new born babies. More research is required to assess the role of prophylactic corticosteroids preceding elective induction of labour.

Central airway issues in bronchopulmonary dysplasia.

While there is a very large focus on the abnormalities of parenchymal lung development and extensive efforts to minimize alveolar damage with "gentle ventilation" and noninvasive respiratory support for neonates with bronchopulmonary dysplasia (BPD), there is relatively little consideration for the implications of central airway disease in this patient population. There are significant changes in the structure and conformation of the central airway during the last half of gestation, and premature birth disrupts this natural developmental process. The arrest of maturation results in a smaller airway that is more compliant, easier to deform, and more susceptible to damage. Consequently, neonates with BPD are prone to developing central airway pathology, particularly for patients who require intubation and positive pressure ventilation. Central airway disease can be divided into dynamic and fixed airway obstruction and results in increased respiratory morbidity in neonates with chronic lung disease of prematurity.

Association between Respiratory Morbidity and Labor in Pregnancies with Gestational Diabetes Mellitus.

This study aimed to the assess risk of respiratory morbidity in neonates born to women with gestational diabetes mellitus (GDM) delivered after labor compared with those delivered without exposure to labor. This is a secondary analysis of a prospective single-center cohort study of singleton pregnancies complicated by GDM. Neonates who were liveborn and delivered at ≥34 weeks' gestation were included. The primary outcome was respiratory morbidity defined as respiratory distress syndrome (RDS) or transient tachypnea of the newborn (TTN) resulting in neonatal intensive care unit (NICU) admission. Neonates born after labor (either spontaneous or induced) were compared with those delivered by cesarean delivery without labor. Associations between labor and neonatal morbidities were estimated using logistic regression. Covariates were adjusted for if they differed significantly between neonates exposed to and not exposed to labor (p < 0.05) and there was biologic plausibility that they would affect neonatal respiratory morbidity. Of the 581 neonates meeting study inclusion criteria, 23.2% delivered without exposure to labor. Those who did and did not experience labor delivered at similar gestational ages (38.6 vs. 38.4 weeks). Thirty-six neonates (6.2%) developed RDS or TTN and were admitted to the NICU. Exposure to labor was associated with a lower frequency of respiratory morbidity requiring admission to NICU, 4.9% (22/446) versus 10.4% (14/135) (p = 0.04). After adjusting for parity, body mass index, birth weight, gestational weight gain more than Institute of Medicine guidelines, race, and exposure to labor were associated with an adjusted odds ratio of 0.41 (95% confidence interval: 0.18-0.89). Exposure to labor was associated with decreased odds of respiratory morbidity in neonates born to mothers with GDM. Limiting elective cesarean in this population can reduce health care costs and optimize neonatal health. · Labor is associated with less respiratory morbidity.. · We should limit elective cesarean delivery with GDM.. · This approach could reduce health care costs..

Severe Pulmonary Air Leak Complicating Neonatal Resuscitation

Air leaks are an important respiratory morbidity in neonates and can result from positive pressure breaths administered at birth. The presentations can vary from being asymptomatic to severe respiratory distress and hypoxaemia. This report is about a term boy who presented with respiratory distress immediately after birth, following resuscitation. He also had a diffuse swelling in the nape of the neck and interscapular region with crepitus on palpation. Serial chest radiographs initially revealed a pneumomediastinum and a subcutaneous emphysema, followed later by a right-sided pneumothorax. After chest drain insertion and supportive care, the air leaks resolved, with no residual complications. Severe air leaks with multi-site air tracking can rarely complicate positive pressure administration at birth, requiring timely intervention to optimise outcomes.

998: Association between labor and neonatal respiratory morbidity in pregnancies complicated by gestational diabetes mellitus

Neonates born to women with gestational diabetes mellitus (GDM) have historically been thought to be at increased risk of respiratory morbidity but it is uncertain whether or how exposure to labor affects this association. Therefore, we sought to assess the risk of respiratory complications in neonates who were delivered after labor compared to those who did not experience labor among a cohort of neonates born to women with GDM. A prospective cohort study of singleton pregnancies complicated by GDM in which the infants were live born at ≥34 weeks. The primary outcome for this analysis was respiratory distress syndrome (RDS) or transient tachypnea of the newborn (TTN) which resulted in neonatal intensive care unit (NICU) admission. Neonates who experienced labor (either spontaneous or induced) were compared to those who delivered by cesarean without labor. Covariates, including gestational age, were investigated and adjusted for if the p-value was <0.05. Of the 292 neonates meeting study inclusion criteria, 25 (8.6%) developed RDS or TTN and required NICU admission (median length of stay = 7 days). Seventy four delivered without labor (25 by primary cesarean delivery [CD] and 49 by repeat CD) and 218 delivered after labor (46 by CD and 172 vaginally). Those who delivered without labor and those who labored delivered at similar gestational ages (38.4 v. 38.6 weeks), but differed with regard to age and race. Not laboring, compared to laboring, was associated with a significantly higher risk of the primary outcome, 13.5% v. 4.1% (OR 3.6; 95% CI 1.4-9.3). Even after adjusting for age and race, those who did not labor had a higher risk of the primary outcome (aOR 4.2; 95% CI 1.2-14.9). Exposure to labor is associated with a decreased risk of respiratory morbidity in neonates born in the late preterm or term period to mothers with GDM.

Comparing neonatal respiratory morbidity in neonates delivered after 34 weeks of gestation with and without antenatal corticosteroid.

Objective:To investigate the effect of antenatal corticosteroid prophylaxis on neonatal respiratory morbidity between 34 and 37 weeks of gestation.Methods:This retrospective study evaluated the neonatal respiratory complications of 683 low risk singleton pregnancies delivered at 34-37 weeks of gestation in a tertiary care center between Jan 2012 and Sept 2015. Group-I (n=294) comprised data of woman who did not receive betamethasone and Group-II(n=396) comprised those who received betamethasone after 34 weeks of gestation for cases at risk of preterm birth. Primary outcome was neonatal respiratory morbidity (NRM). NRM was defined as any respiratory disease that required medical support including supplemental oxygen, nasal continuous positive airway pressure, endotracheal intubation, or exogenous surfactant, with more than 25% oxygen for > 10 minute to maintain neonate oxygen saturation >90% Demographic characteristics, mode of delivery, fetal birth weight and neonatal respiratory complications was compared between the two groups.Results:There was no statistically significant difference for neonatal respiratory morbidity development rate between patients who received betamethasone or those who did not receive it. The incidence of neonatal respiratory morbidity was similar (15.3% in the control group and 14.9% in the intervention group; p=0.88).Conclusion:We found no improvement with betamethasone administration empirically in late preterm birth as regards prevention of Neonatal Respiratory Morbidity(NRM).

Risk of respiratory morbidity in term infants delivered by elective cesarean delivery

Background: The incidence of elective cesarean delivery (ECD) at term is rapidly increasing in the last decades, which is significantly contributing to neonatal respiratory morbidity. Objective: To study the risk of respiratory morbidity in neonates delivered by ECD at term. Material and Methods: Descriptive prospective hospital-based study involving 511 women who delivered by ECD at term in Khartoum Teaching Hospital (KTH) and Omdurman Maternity Hospital (OMH). The cases of this study include all singleton neonates born to mothers delivered by ECD at (37–40 weeks) of gestation at OMH and KTH between April 1, 2010, and February 28, 2011. The study cases were neonates born to mothers delivered by ECD at 37–40 weeks’ gestation. Cases were matched for gestational age, maternal age, parity, baby weight, and maternal body weight. Apgar score and examination of the neonates were carried out and recorded by the pediatric team. Result: The majority of women recruited in this study delivered at 38–39 weeks’ gestational age, and their ages were between 26 and 30 years. Results showed that most of the babies delivered with weight

Maternal and Neonatal Outcomes in Electively Induced Low-Risk Term Pregnancies

Objective Elective induction of labor has been discouraged over concerns regarding increased complications. We evaluated the mode of delivery and maternal and neonatal morbidities in low-risk patients whose labor was electively induced or expectantly managed at term. Study Design This was a retrospective cross-sectional study from 12 US institutions (19 hospitals), 2002 through 2008 (Safe Labor Consortium). Healthy women with viable, vertex singleton pregnancies at 37-41 weeks of gestation were included. Women electively induced in each week were compared with women managed expectantly. The primary outcome was mode of delivery. Results Of 131,243 low-risk deliveries, 13,242 (10.1%) were electively induced. The risk of cesarean delivery was lower at each week of gestation with elective induction vs expectant management regardless of parity and modified Bishop score (for unfavorable nulliparous patients at: 37 weeks = 18.6% vs 34.2%, adjusted odds ratio, 0.40; [95% confidence interval, 0.18–0.88]; 38 weeks = 28.4% vs 35.4%, 0.65 [0.49–0.85]; 39 weeks = 23.6% vs 38.5%, 0.47 [0.38–0.57]; 40 weeks = 32.3% vs 42.3%, 0.70 [0.59–0.81]). Maternal infections were significantly lower with elective inductions. Major, minor, and respiratory neonatal morbidity composites were lower with elective inductions at ≥38 weeks (for nulliparous patients at: 38 weeks = adjusted odds ratio, 0.43; [95% confidence interval, 0.26–0.72]; 39 weeks = 0.75 [0.61–0.92]; 40 weeks = 0.65 [0.54–0.80]). Conclusion Elective induction of labor at term is associated with decreased risks of cesarean delivery and other maternal and neonatal morbidities compared with expectant management regardless of parity or cervical status on admission.

Neonatal respiratory morbidity in the early term delivery

The purpose of this study was to evaluate the risk of respiratory morbidity in neonates delivered at "early term" (37-38 weeks) compared with those delivered at 39 weeks. We conducted a retrospective cohort study of singleton deliveries from 37(0/7) to 39(6/7) weeks' gestation. Our primary outcome was composite respiratory morbidity. Of 2273 deliveries at 37-39 weeks, 51% (n = 1169) delivered in the early term period. Infants delivered at 37-38 weeks had a 2-fold increased risk of respiratory distress syndrome, oxygen use, continuous positive airway pressure use, and composite respiratory morbidity (risk ratio [RR], 2.9; 95% confidence interval [CI], 1.0-7.9; oxygen usage RR, 2.0; 95% CI, 1.4-2.9; continuous positive airway pressure RR, 1.9; 95% CI, 1.1-3.2; composite respiratory morbidity RR, 2.0; 95% CI, 1.4-2.8). The 2-fold increased risk of composite respiratory morbidity of infants in the early term period supports the urgency for limiting nonindicated deliveries to ≥ 39 weeks' gestation.

Antenatal Steroids for Treatment of Fetal Lung Immaturity After 34 Weeks of Gestation

To estimate whether antenatal corticosteroids given after fetal lung immaturity in pregnancies at 34 weeks of gestation or more would improve neonatal outcomes and, in particular, respiratory outcomes. We compared outcomes of 362 neonates born at 34 weeks of gestation or more after fetal lung maturity testing: 102 with immature fetal lung indices were treated with antenatal corticosteroids followed by planned delivery within 1 week; 76 with immature fetal lung indices were managed expectantly; and 184 were delivered after mature amniocentesis. Primary outcomes were composites of neonatal and respiratory morbidity. Compared with corticosteroid-exposed neonates those born after mature amniocentesis had lower rates of adverse neonatal (26.5% compared with 14.1%, adjusted odds ratio [OR] 0.51, 95% confidence interval [CI] 0.27-0.96) and adverse respiratory outcomes (9.8% compared with 3.3%, adjusted OR 0.33, 95% CI 0.11-0.98); newborns born after expectant management had significantly less respiratory morbidity (1.3% compared with 9.8%, adjusted OR 0.11, 95% CI 0.01-0.92) compared with corticosteroid-exposed newborns. Administration of antenatal corticosteroids after immature fetal lung indices did not reduce respiratory morbidity in neonates born at 34 weeks of gestation or more. Our study supports prolonging gestation until delivery is otherwise indicated. II.

Neonatal respiratory morbidity after elective cesarean section

Objective. The objective of this study was to examine the rate of respiratory morbidity in neonates delivered by elective cesarean delivery (ECD) at term, with a definite confirmation of gestational age (GA) by 1st-trimester ultrasound.Methods. Consecutive women carrying a singleton pregnancy and undergoing ECD at term (>38 1/7 weeks), confirmed by 1st-trimester ultrasound, were included in the study group. Multiple gestations, cesarean section (CS) in labor, CS performed after rupture of membranes and induced deliveries were excluded. The control group included women with a singleton pregnancy at term (>38 1/7 weeks) who delivered spontaneously. This group of women was randomly selected during the study period.Results. The study group included 277 women delivered by ECD. The control group consisted of 311 women. Five newborns in the study group and none in the control group were admitted to the neonatal intensive care unit (NICU) due to respiratory disorders (p < 0.02). Excluding diabetic women did not change the results. On multivariate analysis, no other factors were found to independently influence the risk of respiratory complications.Conclusion. In our study, the rate of respiratory morbidity was found to be significantly higher in neonates delivered by ECD compared to those delivered vaginally. The fact that GA was confirmed by 1st-trimester ultrasound makes iatrogenic prematurity an unlikely sole cause for this excess morbidity.

Higher rates of neonatal respiratory morbidity after elective cesarean section

ELECTIVE CESAREAN SECTION LIMOR HELPMAN, YAEL WILNAI, JESSICA ASCHER-LANDSBERG, MICHAEL KUPFERMINC, MICHAEL SHENHAV, SHAUL DOLLBERG, ARIEL MANY, Tel Aviv Sourasky Medical Center Tel Aviv University, Obstetrics and Gynecology, Tel Aviv, Israel OBJECTIVE: Cesarean section (CS) rate has increased over the last few decades. A large proportion of it is due to elective CS. Respiratory complications (RDS, transient tachypnea of the newborn, etc) are the foremost causes of neonatal morbidity and are increased after elective CS. The reason for this higher incidence is unclear. The most widely accepted explanation is iatrogenic prematurity due to unconfirmed dating. Recently, some reports have suggested that the labor process itself affects neonatal respiratory function, thus reducing the rate of respiratory morbidity. The objective of this study was to examine the rate of respiratory morbidity in neonates delivered by elective CS at term, with a definite confirmation of gestational age (GA) by 1st-trimester ultrasound. STUDY DESIGN: Consecutive women carrying a singleton pregnancy and undergoing elective CS at term (>38 1/7 weeks), confirmed by 1st-trimester ultrasound, were included in the study group. Multiple gestation, CS in labor, and CS performed after rupture of membranes were excluded. The control group included women with a singleton pregnancy at term (>38 1/7 weeks) who delivered spontaneously. This group of women was randomly selected during the study period. RESULTS: 277 women delivered by elective CS were included in the study group. The control group consisted of 311 women. 5 newborns in the study group and none in the control group were admitted to the NICU due to respiratory disorders (P < 0.02). Excluding diabetic women did not change the results. On multivariate analysis, no other factors were found to independently influence the risk of respiratory complications. CONCLUSION: In our study, the rate of respiratory morbidity was found to be significantly higher in neonates delivered by elective CS in comparison to those delivered vaginally. The fact that GA was confirmed by 1st-trimester ultrasound makes iatrogenic prematurity an unlikely sole cause for this excess morbidity.