Disturbances in the Acute Cardiorespiratory Adaptation of Full-Term Neonates

Summary

We studied the incidence and causes of transition disturbances in the first 30 minutes of life in full-term newborns. This one-year study was retrospective and included 1147 full- term live-born neonates without life-threatening congenital anomalies and surgical complications. They were divided into four groups: 0 (with normal transition), 1 (resuscitated without endotracheal intubation), and 2 (intubated); A (without underlying maternal, obstetric or fetal/neonatal problem, with adequate for GA eight and from single birth) and B (with one or more of following: underlying maternal, obstetric or fetal/neonatal problem, SGA or LGA, from multiple pregnancies).

Of the newborns, 9.1% of required resuscitation and 1.6% - extensive resuscitation with intubation. The groups significantly differed in the incidence of underlying maternal, obstetric, or fetal/neonatal problems. Resuscitated babies were born via Caesarean section (CS), in abnormal presentation (PaN) and by vacuum extraction or forceps (V/F) predominantly. The highest incidence of the small for gestational age (GA) babies – SGA, was detected in Group 2. Twins and large for GA (LGA) had prevalence in Group 1. Resuscitation was necessary for 18.1% of CS-delivered babies. V/F and PaN lead to the highest need for intubation. According to our data, every 10th of the full-term neonates required assistance in the fetal-to-neonatal transition. The causes could be diseases of the mother or fetus/newborn, multiple births, SGA, or LGA. A compromised medical decision about the time and way of delivery may result in iatrogenic transition disturbances.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Askin, D. Fetal-to-neonatal transition. What is normal and what is not? Part 1: The physiology of transition. Neonatal Netw. 2009;28(3):33-40.

  • 2. Hillman N, Kallapur SG, Jobe A. Physiology of transition from intrauterine to Extrauterine Life. Clin Perinatol. 2012;39(4):769-83.

  • 3. Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59.

  • 4. World Health Organization [Internet]. Guidelines on basic newborn resuscitation; 2012 [cited 2019 Mar 8]. Available from: http://www.who.int/iris/handle/10665/75157

  • 5. Morton S, Brodsky D. Fetal Physiology and the Transition to Extrauterine Life. ClinPerinatol. 2016;43(3):395-407.

  • 6. Blank DA, Kamlin COF, Rogerson SR, Fox LM, Lorenz L, Kane SC, et al. Lung ultrasound immediately after birth to describe normal neonatal transition: an observational study. Arch Dis Child Fetal Neonatal Ed. 2018;103:157-62.

  • 7. Askin DF. Fetal-to-Neonatal Transition - What is Normal and What is Not? Neonatal Netw, 2009;28(3):33-40.

  • 8. Mercer J, Erickson-Owens D, Graves B, Haley M. Evidence-Based Practices for the Fetal to Newborn Transition. J Midwifery Womens Health. 2007;52(3):262-72.

  • 9. Burt R, Vaughan T, Daling J. Evaluating the Risks of Cesarean Section: Low Apgar Score in Repeat C-Section and Vaginal Deliveries. Am J Public Health.1988;78:1312-4.

  • 10. Urlesberger B, Kratky E, Rehak T, Pocivalnik M, Avian A, Czihak J, et al. Regional oxygen saturation of the brain during birth transition of term infants: comparison between elective cesarean and vaginal deliveries. J Pediatr.2011;159(3):404-8.

  • 11. Persson M, Johansson S, Villamor E, Cnattingius S. Maternal Overweight and Obesity and Risks of Severe Birth-Asphyxia-Related Complications in Term Infants: A Population- Based Cohort Study in Sweden. PLoS Med. 2014;11(5):e1001648.

  • 12. Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al. Part 13: neonatal resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(suppl 2):543-60.

  • 13. Antonucci R, Porcella A, Pilloni MD. Perinatal asphyxia in the term newborn. J PediatrNeonat lndividual Med. 2014;3(2):e030269.

  • 14. Van Vonderen JJ, Roest AA, Siew ML, Walther FJ, Hooper SB, te Pas AB. Measuring Physiological Changes during the Transition to Life after Birth. Neonatology.2014;105:230-42.

  • 15. Hutchon DJ. Strictly Physiological Neonatal Transition at Birth. Health Sci J. 2016;10(2):1-3.

  • 16. HansenAK, Wisborg K, UldbjergN, HenriksenTB. Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study.BMJ.2008;336:85.

  • 17. Levine EM, Ghai V, Barton JJ, Strom CM. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol. 2001;97(3):439-42.

  • 18. Yee W, Amin H, Wood S. Elective cesarean delivery, neonatal intensive care unit admission, and neonatal respiratory distress. Obstet Gynecol. 2008;111(4):823-8.

OPEN ACCESS

Journal + Issues

Search