Delayed Lung Liquid Absorption after Cesarean Section at Term

Martelius, Laura; Janér, Cecilia; Süvari, Liina; Helve, Otto; Lauerma, Kirsi-Maria Susanna; Pitkänen, Olli; Andersson, Sture

doi:10.1159/000351290

Cited by 34 publications

(36 citation statements)

References 27 publications

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“…In rabbits, operative delivery without onset of labor is associated with retention of lung liquid [20]. Term infants born by elective cesarean section have significantly higher B-line scores in US than infants born vaginally, suggesting delayed lung liquid clearance possibly due to impaired epithelial sodium channel activity [4]. …”

Section: Discussionmentioning

confidence: 99%

“…The abundance of B-lines was scored by a pediatric radiologist blinded to the identity and age of the infant and the result of the LC measurement on a 5-step scale (1: no artifact, 2: B-lines in <25% of surface area, 3: <50%, 4: <75% and 5: >75%). A mean score of the 6 views was calculated [4]. Separate US scores for the upper and lower chest fields were also calculated.…”

Section: Methodsmentioning

confidence: 99%

“…1) [3]. Healthy neonates present with B-lines, which decrease during the first 36 h. This is likely to reflect a normal decrease in lung water content after birth [4,5]. Numerous B-lines predict the need for respiratory support and failure of noninvasive ventilation support [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Lung Ultrasound and Static Lung Compliance during Postnatal Adaptation in Healthy Term Infants

et al. 2015

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Background: B-lines in lung ultrasound can be used to estimate lung liquid. B-lines are ring-down artifacts that arise from alterations to subpleural lung parenchyma. Lung ultrasound has been used to differentiate between diseases causing respiratory symptoms in neonates. B-lines are also seen in healthy infants during postnatal adaptation. Static lung compliance is a measure of the elasticity of the lungs. Objectives: Our aim was to document lung ultrasound findings, static lung compliance and their relationship during postnatal adaptation in healthy term infants. Methods: Lung ultrasound and measurement of static lung compliance were performed in 34 infants at ages of 0-4 and 24 h. B-lines in lung ultrasound were scored using a 5-step scale. Separate ultrasound scores for the upper and lower fields were also calculated. Results: A significant decrease in the abundance of B-lines and a concomitant significant improvement in static lung compliance was observed from <4 to 24 h of age. At <4 h the B-lines were significantly more abundant in the lower fields. No significant correlation existed between lung ultrasound and static lung compliance. Conclusion: The concomitant decrease in the B-lines in ultrasound and the increase in lung compliance during the first 24 h are likely to reflect clearance of lung liquid.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Lung Ultrasound and Static Lung Compliance during Postnatal Adaptation in Healthy Term Infants

et al. 2015

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“…B-lines project from the pleural line to the edge of the screen, erase A-lines, and move with respiration [11]. Because the fetal lung has a high fluid content, B-lines can be seen in the first day of life also in neonates without respiratory distress [12]. …”

Section: Methodsmentioning

confidence: 99%

Lung Ultrasound Accuracy in Respiratory Distress Syndrome and Transient Tachypnea of the Newborn

et al. 2014

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Background: Lung ultrasound (LUS) is a promising technique for the diagnosis of neonatal respiratory diseases. Preliminary data has shown a good sensitivity and specificity of LUS in the diagnosis of respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN). Objective: The aim of this study was to calculate the sensitivity, specificity, and negative (NPV) and positive predictive value (PPV) of LUS for RDS and TTN, using an external reader blinded to the clinical condition. Design and Methods: Neonates with respiratory distress had a LUS within 1 h of admission. Images were uploaded and sent to the external reader, who made the ultrasound diagnosis according to the appearance of the images. The final clinical diagnosis was made according to all the available data, except LUS data. Sensitivity, specificity, PPV, and NPV were calculated considering the final clinical diagnosis as the gold standard. Results: Fifty-nine neonates were studied (mean gestational age: 33 ± 4 weeks, mean birth weight: 2,145 ± 757 g). Twenty-three infants had a final diagnosis of RDS and 30 of TTN. LUS showed a sensitivity of 95.6% and specificity of 94.4%, with a PPV of 91.6% and a NPV of 97.1% for RDS, and a sensitivity of 93.3% and specificity of 96.5% with a PPV of 96.5% and a NPV of 93.4% for TTN. Conclusions: LUS showed high sensitivity and specificity in diagnosing RDS and TTN.

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“…Therefore, in addition to higher cortisol concentrations, higher SGK1 expression after VD could be associated with the rise of catecholamine concentrations during labor. Higher SGK1 expression after VD may be related to that, even in the absence of respiratory distress, lung liquid content at 3 h postnatally is significantly higher after elective CD than VD [23]. The present findings of lower circulating cortisol and SGK1 expression in infants born before 39 weeks or by CD suggest that premature delivery by CD constitutes a ‘double-hit' increasing the risk of pulmonary maladaptation related to insufficient transcription of the genes involved in epithelial sodium and water absorption [15].…”

Section: Discussionmentioning

confidence: 99%

Duration of Gestation and Mode of Delivery Affect the Genes of Transepithelial Sodium Transport in Pulmonary Adaptation

et al. 2014

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Background: Respiratory distress due to inadequate lung liquid clearance is a significant problem in infants delivered late preterm or early term, especially by elective cesarean delivery (CD). Lung liquid clearance depends on epithelial ion transport and in animals is induced by glucocorticoids. Objectives: In newborn late preterm and term infants to study airway epithelial gene expressions of epithelial sodium channel (ENaC), and the serum and glucocorticoid-inducible kinase 1 (SGK1), and their association with cortisol, mode of delivery, and gestational age (GA). Methods: Infants were delivered at 35^0/7-41^6/7 weeks. Cortisol in umbilical cord plasma was analyzed with liquid chromatography-tandem mass spectrometry. ENaC and SGK1 mRNAs in airway epithelial cells obtained within 3 h and at 1 day postnatally were quantified with real-time PCR. Results: ENaC and SGK1 mRNAs were significantly lower in late preterm and early term infants than in those ≥39^0/7 weeks. Significant correlations existed between both ENaC and SGK1 and cord cortisol and GA. In term infants, SGK1 mRNA at 1.5 h was higher after vaginal delivery than elective CD. Conclusions: In late preterm and early term infants, low expression of ENaC and SGK1 may parallel insufficient lung liquid clearance predisposing to respiratory distress. Lower SGK1 expression after term CD could translate into insufficient sodium and lung liquid absorption. The findings demonstrate a central role for cortisol in regulation of ENaC and potentially perinatal sodium and lung liquid clearance.

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Delayed Lung Liquid Absorption after Cesarean Section at Term

Cited by 34 publications

References 27 publications

Lung Ultrasound and Static Lung Compliance during Postnatal Adaptation in Healthy Term Infants

Lung Ultrasound and Static Lung Compliance during Postnatal Adaptation in Healthy Term Infants

Lung Ultrasound Accuracy in Respiratory Distress Syndrome and Transient Tachypnea of the Newborn

Duration of Gestation and Mode of Delivery Affect the Genes of Transepithelial Sodium Transport in Pulmonary Adaptation

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