Do very sick neonates born at term have antenatal risks?

Abstract

The pathways to neonatal respiratory morbidity in term infants are multifactorial. Several areas which warrant more in-depth study are: elective cesarean section at 37-38 weeks gestation, fetal growth restriction, macrosomia and the pattern of in-utero growth, maternal weight gain during pregnancy, gestational diabetes, pyrexia in labor and the role of chorioamnionitis.

Cesarean Delivery on Maternal Request

“…53 The remaining four studies included infants at 37 weeks or more of gestation. 10,47-49, 52 We did not find sufficient evidence to determine whether gestational age alone accounts for the differential risk of respiratory neonatal morbidity associated with cesarean delivery. Four studies provide a subanalysis of outcomes by gestational age.…”

“…47 However, the remaining three studies showed a higher risk of respiratory morbidity in labored cesarean deliveries. 46,52,53 We cannot determine whether the higher risk of respiratory morbidity associated with labored cesarean deliveries in these three studies is caused by transient tachypnea of the newborn, RDS, or meconium aspiration syndrome. Similarly, we cannot determine whether the higher rate can be attributed to a higher rate of emergency cesarean delivery for complications relating to prematurity.…”

“…Four studies provide a subanalysis of outcomes by gestational age. [47][48][49]51,52 These studies consistently reported a significant reduction in the risk of neonatal morbidity from transient tachypnea of the newborn or RDS as gestational age advanced, approaching equality at 39 -40 weeks. No study reported on severity of respiratory morbidity by gestational age.…”

Chorioamnionitis: A Risk Factor for Fetal and Neonatal Morbidity

“…A lower incidence of RDS in babies of mothers with CA has been reported by some authors [87,101,102] but not by others; the latter mention CA and TNF-alpha in the amniotic fluid in infants with RDS and consider CA as a risk factor for lung problems in term infants [103,104]. Considering the complex mechanism by which infection affects lung maturation and the recently demonstrated relationships between RDS and an increase in MMP-8 [105], further studies on accurately selected populations of premature and full-term babies are needed to clarify the relationships between CA and RDS.…”

Surveillance du travail dans les situations à risque

“…On note une fréquence plus importante de scores d'Apgar bas [84] (NP4) sans augmentation significative des acidoses néonatales [90] (NP2), ainsi qu'un nombre plus important de détresses respiratoires [83,85,91] (NP4), d'inhalations méconiales [83] (NP4), d'infections néonatales [90,92] (NP2) et de transferts en soins intensifs [86] (NP4). Ces complications s'accompagnent d'une légère augmentation du risque de décès néonatal, notamment d'origine infectieuse, pour les naissances prématurées ou à terme [83] (NP4).…”