Mino Yoichi, Miyahara Fumiko, Miura Mazumi, Imamoto Aya, Fujii Hiromi, Moriwaki Chisaki, Yoshioka Kazuki, Namba Noriyuki
Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan.
Yonago Acta Med. 2024 May 11;67(2):150-156. doi: 10.33160/yam.2024.05.009. eCollection 2024 May.
Elective cesarean sections (ECSs) for early-term pregnancies at 37 weeks of gestational age (GA) aim to reduce the risk of emergency cesarean sections due to the onset of labor or rupture of membranes. However, resultant increases in neonatal respiratory disorders, including transient tachypnea of the newborn (TTN) have been observed. However, few studies have elucidated the associated risk factors. Consequently, we aimed to determine whether differences existed in the clinical outcomes between neonates delivered via ECS at 37 weeks and those delivered at ≥ 38 weeks of GA.
A retrospective analysis was conducted on 259 neonates born via ECS at Tottori University Hospital, between January 2013 and December 2019, with birthweights ≥ 2500 g and GAs > 37 weeks. The neonates were categorized into two cohorts: births at 37 and at ≥ 38 weeks of GA (37-week and 38-week cohorts). The principal clinical outcomes included the appearance, pulse, grimace, activity, and respiration (Apgar) scores, need for positive-pressure ventilation, incidence of TTN, and length of hospital stay.
No statistically significant differences were observed in the indications for ECS, sex, or birthweight between the two cohorts. The 37-week cohort exhibited a lower 1-min Apgar score than did the 38-week cohort, with no statistically significant differences between the two cohorts, at 5 min. Statistically significant differences were not observed in the need for positive-pressure ventilation during initial resuscitation or length of hospital stay for patients with TTN between the two cohorts. Notably, the 37-week cohort exhibited a significantly higher incidence of TTN than did the 38-week cohort.
ECSs at 37 weeks of GA exhibited an increased risk of TTN than ECSs at ≥ 38 weeks of GA. Strategic neonatal care and adequate preparation can mitigate this risk without affecting the length of hospital stay.
孕37周时进行择期剖宫产（ECS）旨在降低因临产或胎膜破裂而进行急诊剖宫产的风险。然而，已观察到新生儿呼吸系统疾病的发生率有所增加，包括新生儿短暂性呼吸急促（TTN）。然而，很少有研究阐明相关的危险因素。因此，我们旨在确定孕37周时通过ECS分娩的新生儿与孕38周及以上分娩的新生儿在临床结局上是否存在差异。
对2013年1月至2019年12月在鸟取大学医院通过ECS出生、出生体重≥2500g且孕周>37周的259例新生儿进行回顾性分析。将新生儿分为两个队列：孕37周出生和孕38周及以上出生（37周队列和38周队列）。主要临床结局包括外观、脉搏、 grimace、活动和呼吸（Apgar）评分、正压通气需求、TTN发生率和住院时间。
两组队列在ECS指征、性别或出生体重方面未观察到统计学上的显著差异。37周队列的1分钟Apgar评分低于38周队列，两组在5分钟时无统计学显著差异。两组队列在初始复苏期间正压通气需求或TTN患者住院时间方面未观察到统计学显著差异。值得注意的是，37周队列的TTN发生率明显高于38周队列。
孕37周时的ECS与孕38周及以上时的ECS相比，TTN风险增加。战略性的新生儿护理和充分的准备可以减轻这种风险，而不会影响住院时间。
