Effects of delivery by caesarean section on lung mechanics and lung volume in the human neonate.

Milner, Anthony; Saunders, Richard; Hopkin, I E

doi:10.1136/adc.53.7.545

Cited by 95 publications

(47 citation statements)

References 17 publications

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“…This has been attributed to delayed lung fluid removal in those infants (24). When lung volumes in term infants soon after birth after no labor were compared with those of infants born after normal vaginal delivery, the most striking difference was significantly reduced total lung volumes in the no labor group despite similar thoracic circumference (25). The authors concluded that an increased lung liquid volume with decreased gas component may be the reason for these findings.…”

Section: Discussionmentioning

confidence: 67%

Airway Ion Transport on the First Postnatal Day in Infants Delivered Vaginally or by Elective Cesarean Section

et al. 2003

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To determine airway ion transport in term infants on the first day of postnatal life, and to test the hypothesis that infants born without labor have reduced sodium absorption, we measured nasal potential difference using a modified perfusion protocol suitable for newborn infants. We examined maximal stable baseline potential difference, the change after perfusion with 10 Ϫ4 M amiloride (⌬amil), and the change after perfusion with a zerochloride solution (⌬zero Cl Ϫ ) in infants born after elective cesarean section (n ϭ 21) or normal labor (n ϭ 20). Maximal stable baseline potential difference was not different in the two cohorts (Ϫ24.0 mV, range Ϫ9 to Ϫ64 mV versus Ϫ25.5 mV, range Ϫ6 to Ϫ44 mV). The majority of infants in both cohorts showed a substantial fall in potential difference after amiloride perfusion, and there was little capacity for chloride secretion. These results demonstrate a fluid absorptive pattern in the airways on the first postnatal day. In these well infants, the ion transport phenotype was not dependent on the presence or absence of labor. The fetal lung is filled with fluid, secreted by pulmonary epithelial cells through active Cl Ϫ transport into the bronchial lumen with water moving along the osmotic gradient (1). Lung fluid production slows in late gestation (2). At the time of birth, changes in airway ion transport facilitate the adaptation to postnatal life and air breathing (3). Chloride ion secretion slows and Na/K ATPases in the basal membrane of the pulmonary epithelial cell actively transport Na ϩ out of the cell, creating a transcellular gradient for Na ϩ absorption, mediated through the apical ENaC (4).The ENaC is composed of three homologous subunits, ␣, ␤, and ␥, that together form a functional ion channel (5). In the human lung, ENaC expression has been found along the whole of the respiratory tract, from the nasal epithelium to the alveoli (6, 7).Several important findings point to a critical role for the ENaC in the removal of lung fluid during the later stages of gestation and after birth. Expression of ENaC, especially the ␣ subunit, increases in the respiratory tract with advancing gestational age in humans (8). In the animal model, ENaC expression is further increased by administration of antenatal steroids (9). Transgenic knockout mice with the ␣ENaC gene disrupted die soon after birth from an inability to remove fluid from their lungs (10). ENaC can be effectively blocked by the drug amiloride, which acts as a competitive antagonist to Na ϩ absorption (11). Instillation of amiloride into the lungs of guinea pigs just before their birth results in severe respiratory distress after delivery (12). Animal studies have demonstrated the importance of lung fluid removal on postnatal adaptation (13). Lambs born immediately after removal of half their lung fluid had significantly improved oxygenation and carbon dioxide clearance in the first few hours after birth compared with a control group.The processes that determine the change in ion transport pattern at birth are not f...

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Section: Discussionmentioning

confidence: 67%

Airway Ion Transport on the First Postnatal Day in Infants Delivered Vaginally or by Elective Cesarean Section

et al. 2003

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“…These changes are mediated by circulating catecholamines, steroids, vasopressin and by the increased oxygen tension [2,[4][5][6] . TTN is more frequent in infants born by cesarean section in the absence of labor because of lower levels of catecholamines compared to infants born vaginally and the absence of thoracic compression which occurs during vaginal delivery [7,8] .…”

Section: Introductionmentioning

confidence: 99%

The ‘Double Lung Point’: An Ultrasound Sign Diagnostic of Transient Tachypnea of the Newborn

Copetti¹,

2006

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Background: Transient tachypnea of the newborn (TTN) is a mild form of neonatal respiratory distress which early in its course needs to be differentiated from other severe respiratory disorders. At present the diagnosis is based on radiological findings and clinical course. Lung sonography in TTN has not yet been assessed. Objectives: The aim of the study was to define the ultrasonographic appearance of TTN and evaluate its clinical relevance. Methods: Lung sonography was performed in 32 newborn infants with radiological and clinical signs of TTN within the first hour after birth and the findings were compared with those of 60 normal infants, 29 with respiratory distress syndrome, 6 with pneumonia, 5 with pulmonary hemorrhage and 5 with atelectasis. Results: In the infants with TTN, lung sonography showed a difference in lung echogenicity between the upper and lower lung areas. There were very compact comet-tail artifacts in the inferior fields while these were rare in the superior fields. We designated this finding the ‘double lung point’ and it was not observed in healthy infants, infants with respiratory distress syndrome, actelectasis, pneumothorax, pneumonia, or pulmonary hemorrhage. Sensitivity and specificity of the double lung point was 100% for the diagnosis of TTN. Conclusion: We found lung sonography reliable for the early diagnosis of TTN. We suggest that it should become the first approach for imaging of neonatal respiratory distress although further prospective studies with good blinding need to be performed.

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“…Assuming similar carbon dioxide production rates, alveolar ventilation was probably simi lar also. Infants born by C-section have a decreased total lung volume, minute volume, dynamic compliance and increased total re spiratory resistance [16], We speculate that tachypnea in these infants with a normal pCCU represents a compensation for altered lung mechanics rather than a primary change in the pattern of breathing.…”

Section: Discussionmentioning

confidence: 99%

Transient Respiratory Difficulty following Cesarian Delivery

Patel¹,

Donovan²,

Keenan³

1983

Neonatology

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57 newborn infants delivered by planned, repeat cesarian section were studied to determine the role of surfactant in transient neonatal respiratory distress. 22.8% of the newborn infants studied had transient tachypnea of the newborn. The mean amniotic fluid lecithin-sphingomyelin ratio (L/S) was 2.8 in normal infants and 2.6 in infants with transient tachypnea. The mean gastric aspirate L/S at the time of delivery was 3.0 in the normal infants and 2.7 in infants with transient tachypnea. There were no statistically significant differences in either amniotic fluid L/S or gastric aspirate L/S. Based on these results we speculate that, despite altered lung mechanics in neonates with transient tachypnea, lung maturity as determined by L/S ratio does not differ from that of normal neonates.

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Effects of delivery by caesarean section on lung mechanics and lung volume in the human neonate.

Cited by 95 publications

References 17 publications

Airway Ion Transport on the First Postnatal Day in Infants Delivered Vaginally or by Elective Cesarean Section

Airway Ion Transport on the First Postnatal Day in Infants Delivered Vaginally or by Elective Cesarean Section

The ‘Double Lung Point’: An Ultrasound Sign Diagnostic of Transient Tachypnea of the Newborn

Transient Respiratory Difficulty following Cesarian Delivery

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