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Respiratory adaptation in term infants following elective caesarean section
  1. Daragh Finn1,2,
  2. Julie De Meulemeester1,
  3. Lisa Dann1,
  4. Ita Herlihy1,2,
  5. Vicki Livingstone2,
  6. Geraldine B Boylan1,2,
  7. C Anthony Ryan1,2,
  8. Eugene M Dempsey1,2
  1. 1 Department of Paediatrics and Child Health, Cork University Maternity Hospital, Cork, Ireland
  2. 2 Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
  1. Correspondence to Dr Eugene M Dempsey, INFANT Research Centre, Cork University Maternity Hospital, University College Cork, Cork, Ireland; g.dempsey{at}


Objective To determine respiratory rate (RR), tidal volume (TV) and end-tidal carbon dioxide (EtCO2) values in full-term infants immediately after caesarean section, and to assess whether infants that develop transient tachypnoea of the newborn (TTN) follow the same physiological patterns.

Design and patients A Respironics NM3 Monitor (Philips, Netherlands) continuously measured RR, TV and EtCO2 for 7 min in infants >37 weeks’ gestation following elective caesarean section (ECS). Monitoring was repeated at 2 hours of age for 2 min. Gestation, birth weight, Apgar scores and admissions to neonatal unit were documented.

Setting The operative delivery theatre of Cork University Maternity Hospital, Ireland.

Results There were 95 term infants born by ECS included. Median (IQR) gestation was 39 weeks (38.2–39.1) and median (IQR) birth weight 3420 g (3155–3740). Median age at initiation of monitoring was 26.5 s (range: 20–39). Data were analysed for the first 7 min of life. Mean breaths per minute (bpm) increased over the first 7 min of life (44.31–61.62). TV and EtCO2 values were correlated and increased from 1 min until maximum mean values were recorded at 3 min after delivery (5.18 mL/kg–6.44 mL/kg, and 4.32 kPa–5.64 kPa, respectively). Infants admitted to the neonatal unit with TTN had significantly lower RRs from 2 min of age compared with infants not admitted for TTN.

Conclusions TV and EtCO2 values are correlated and increase significantly over the first few minutes following ECS. RR increases gradually from birth, and rates were lower in infants that develop TTN.

  • transition
  • newborn adaptation
  • respiratory function monitoring
  • transient tachypnea of the newborn
  • neonate

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  • Contributors DF designed the study, carried out the data collection, drafted the intial manuscript and revised the final manuscript. JDM, LD, and IH helped design the study, and carried out data collection, revised and critically assessed the final manscript. VL carried out the data analysis and drafted the manuscript. GBB critically reviewed and revised the manuscript. CAR and EMD supervised and assisted with the design of the study, data collection instrument, and critically reviewed and revised the manuscript. All authors interpreted the data, edited the manuscript for intellectual content and approved the final version. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This work was supported Science Foundation Ireland, a Research Centre Award (INFANT-12/RC/2272).

  • Patient consent Obtained from the parents.

  • Ethics approval The Cork Teaching Hospitals’ Research Ethics Committee approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data available upon request from corresponding author.