Original article
The Influence of Timing of Elective Cesarean Section on Risk of Neonatal Pneumothorax

https://doi.org/10.1016/j.jpeds.2006.12.008Get rights and content

Objective

To determine whether the timing of elective cesarean delivery at term influences the risk of neonatal pneumothorax.

Study design

Chart reviews confirmed gestational age, delivery modalities, and diagnosis of pneumothorax of 66,961 term infants delivered in the Veneto region of northern Italy. Of these neonates, 17,783 (26.5%) were delivered by cesarean section, including 9988 elective (56.1%) and 7795 emergency (43.8%).

Results

In 5498 (55.0%) of neonates, an elective cesarean section was performed before 39 completed weeks. Fifty-nine neonates had pneumothorax diagnosed (0.88/1000 births). Neonates delivered by elective cesarean section had an increased incidence of pneumothorax (2.90/1000 births), in comparison with neonates delivered by emergency cesarean (1.53/1000 births; OR 4.21; 95% CI 2.02-8.74) or vaginally delivered (0.39/1000 births; OR 7.95; 95% CI 4.41-14.32). In elective cesarean sections there was a significant progressive reduction in the incidence of pneumothorax from week 37 0/7 to 37 6/7 onward (P < .01).

Conclusions

The timing of elective cesarean section influences the pneumothorax risk. A reduction in neonatal iatrogenic pneumothorax would result if elective deliveries were performed after the 39 completed weeks of pregnancy.

Section snippets

Study Design and Population

All patients with pneumothorax transported to the Veneto region in northeastern Italy, from January 1, 2002 through December 31, 2003 by two dedicated neonatal transport teams of the Pediatric Departments of the Universities of Padua and Verona, respectively, were eligible for inclusion in the study. Inborn neonates with pneumothorax cared for at the Level-III reference centers and those registered in four Level-II hospitals also were included. The transport teams, which include a neonatologist

Results

During the 2-year study period, 87,418 infants were delivered and 66,961 (82.5%) were infants born at term. Of these neonates, 17,783 were delivered by cesarean section (26.5%), including 9988 (56.1%) delivered by elective cesarean and 7795 (43.8%) by emergency cesarean section, and 49,178 (68.0%) vaginally delivered. Fifty-nine neonates had pneumothorax diagnosed (0.8/1000 births) and all were treated with thoracostomy. Neonates delivered by elective cesarean section showed an increased

Discussion

Respiratory morbidity in infants with iatrogenic RDS can be remarkably severe, despite awareness for over a quarter century, and guidelines to minimize its occurrence.9, 16, 17, 18, 19, 20 In this study, we evaluated the contributing of elective cesarean delivery to pneumothorax risk in term neonates delivered in the Veneto region, an industrialized area of northern Italy, during a 2-year period. We found that for term infants elective cesarean delivery resulted in a significantly greater risk

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