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.
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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.