Leukocyte Counts in Relation to the Method of Delivery during the First Five Days of Life

Chirico, G; Gasparoni, Antonella; Ciardelli, Laura; Martinotti, Lucia; Rondini, G

doi:10.1159/000014107

Cited by 39 publications

(28 citation statements)

References 19 publications

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“…Underlying biologic mechanisms might be that neonates born by vaginal deliveries have higher levels of catecholamines and cortisol compared with neonates born by caesarean deliveries (16 -19,33-35). Vaginal delivered neonates with higher umbilical cord blood cortisol levels have higher lymphocyte counts (16,19). It is has been suggested that infants born by a caesarean delivery have less recruitment of lymphocyte subsets due to maternal anesthetics, which crosses the placenta and inhibit release of catecholamines and cortisol (33,36,37).…”

Section: Discussionmentioning

confidence: 99%

Perinatal Stress Influences Lymphocyte Subset Counts in Neonates. The Generation R Study

et al. 2008

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ABSTRACT:In the general population, it is unknown whether stress-related perinatal factors influence lymphocyte subset counts in neonates. The aim of this study was to assess the associations of perinatal factors related to stress and hypoxia (mode of delivery, Apgar scores, and umbilical cord blood pH) with absolute lymphocyte subset counts (T, B, NK, helper T, cytotoxic T, naïve, memory T) in cord blood of 571 neonates. This study was embedded in a population-based prospective cohort study from fetal life onwards. All models were adjusted for gestational age, birth weight, gender, maternal fever, and each of the other perinatal stress-relating factors. Our results showed that increasing stress-related mode of delivery was positively associated with NK and memory T-lymphocyte subset counts (all p Ͻ 0.01). Effects of Apgar scores on lymphocyte subsets were explained by umbilical cord blood pH. Lower umbilical cord blood pH was associated with higher B, NK, and memory Tlymphocyte counts (all p Ͻ 0.05). Effects of mode of delivery and umbilical cord blood pH on other lymphocyte subsets were not observed. We conclude that, in the general population, lymphocyte subset counts in neonates increase with increasing stress-and hypoxia-related perinatal factors. T he immunologic status of the neonate is frequently established by assessing absolute numbers of various lymphocyte subsets in cord blood (1-4). However, such data at birth must be interpreted with care since the lymphocyte subset counts might be influenced by growth, stress, and hypoxia related events that occur in late prenatal and early postnatal life. It has been suggested that the distribution of lymphocyte subsets is related to gestational age at birth and birth weight (5-8). It is not well known whether other perinatal factors associated with fetal well-being, stress and hypoxia, including mode of delivery, Apgar scores, or umbilical cord blood pH, influence the various lymphocyte subset counts at birth.So far, studies on mode of delivery and lymphocyte subsets remain inconclusive. This might be due to small study populations, the variability of lymphocyte subsets studied, or not taking other possible influencing factors into account (5,6,9 -16). Results of the majority of these studies suggested a tendency toward increased lymphocyte subset counts in neonates born by vaginal delivery compared with neonates born by caesarean delivery (9 -11,13-16). The endocrine-metabolic variations during a stressful delivery, particularly hypoxia and the increase of catecholamines and cortisol, were considered as the main cause of these effects (17-19). Additionally to this stress concept, adverse Apgar scores and umbilical cord blood pH, both results of perinatal hypoxia, are thought to influence lymphocyte subset counts at birth (9,20 -22).We examined in 571 neonates participating in a populationbased prospective cohort study, the associations of perinatal factors related to stress and hypoxia, including mode of delivery, Apgar scores, and umbilical cord blood pH with ...

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Section: Discussionmentioning

confidence: 99%

Perinatal Stress Influences Lymphocyte Subset Counts in Neonates. The Generation R Study

et al. 2008

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“…The gestational as well as the infant's age in hours at the time of blood collection, the method of blood sampling and the infant's gender might affect the results as well as the method of delivery, or maternal risk factors like hypertension (Chirico et al, 1999;Christensen et al, 2009;Escobar, 2003;Kayiran et al, 2003;Newman et al, 2010;Schelonka et al, 1995;Schmutz et al, 2008). Even the influence of the sea level on ANC in neonates has been described leading to a wider range of reference values with isolated elevated counts of absolute neutrophil granulocytes but normal IT-ratios in healthy term babies (Lambert et al, 2009).…”

Section: Possible Limitations Of the Use Of Igmentioning

confidence: 99%

The Role of Immature Granulocyte Count and Immature Myeloid Information in the Diagnosis of Neonatal Sepsis

Cimenti¹,

Erwa²,

Resch³

2013

Neonatal Bacterial Infection

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“…On the other hand, caesarean section is associated with delayed intestinal colonization (11), which could deprive the newborn of the immunostimulatory impulses at a very critical period in life when the immune system and the gut barrier maturate (48). Infants born by vaginal delivery have been shown to have higher nonspecific activity of immune system compared with infants born by caesarean section (15,49). Thus caesarean section may be associated with a lack of processes like production of IL-10 (50) or TGF-␤ (19), which could redirect the constitutive Th2-phenotype of the newborn to normal.…”

Section: Discussionmentioning

confidence: 99%

Mode of Delivery and Asthma – Is There a Connection?

Kero

Gissler

Grönlund³

et al. 2002

Pediatr Res

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Genetic factors cannot explain the recent rapid increase in the incidence of atopic diseases. The phenomenon has been explained by environmental factors, and there are data for and against the hypothesis that a decline in the pressure of microbial stimulation early in life could be behind the allergy epidemic. Changes have also occurred in maternity care, among them a rise in the caesarean section rate, which could diminish initial microbial exposure and thereby alter T helper 1 cell/T helper-2 cell development and affect the risk of developing atopy. In this study, we sought to establish whether mode of delivery does influence the development of atopic asthma. Finnish 1987 Medical Birth Register (n ϭ 59,927 live births) information was linked between several national health registers to obtain information on asthma and mode of delivery in children registered. The data were adjusted for maternal age, previous deliveries, child's sex, and birth size. Atopy was evaluated in the second study (Turku Birth Cohort), which involved 219 children born by vaginal delivery (n ϭ 106) or caesarean section (n ϭ 113); history of atopic symptoms was established by questionnaire and a clinical examination was conducted, including skin prick testing and determination of total and allergen-specific IgE in serum.The register study showed the cumulative incidence of asthma at the age of seven to be significantly higher in children born by caesarean section (4.2%) than in those vaginally delivered (3.3%), the adjusted odds ratio (OR) for confounding variables being 1.21 (1.08 -1.36), p Ͻ 0.01. In the second study, significantly more positive allergy tests were reported in questionnaires in the caesarean (22%) than in the vaginal delivery group (11%), OR 2.22 (1.06 -4.64), p Ͻ 0.01, and a trend toward more positive skin prick reactions was documented at clinical examination; 41% versus 29%, OR 1.31 (0.65-2.65), p ϭ 0.11. In conclusion, these results suggest that caesarean section delivery may be associated with an increased prevalence of atopic asthma. During the past two decades the incidence of asthma and other atopic diseases has increased in industrialized countries (1-7). Notwithstanding the marked hereditary element in atopy, this rapid increase may well be attributable to changes in environmental factors, and in this context it is of note that the rate of caesarean section deliveries has more than doubled during the past 20 y and this trend seems to continue (8 -10).The question addressed here was, whether the mode of delivery could be one influencing factor in development of asthma and atopy?Hypothesis for the study came from the findings that caesarean section deliveries interfere with a wide range of physiologic and immunologic factors: establishment of normal intestinal microflora is delayed (11,12), number of fetal neutrophils and natural killer cells is decreased (13,14) and activity of phagocytic function is increased, and these modifications may exert their effects beyond the immediate postnatal period (15). For the ris...

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Leukocyte Counts in Relation to the Method of Delivery during the First Five Days of Life

Cited by 39 publications

References 19 publications

Perinatal Stress Influences Lymphocyte Subset Counts in Neonates. The Generation R Study

Perinatal Stress Influences Lymphocyte Subset Counts in Neonates. The Generation R Study

The Role of Immature Granulocyte Count and Immature Myeloid Information in the Diagnosis of Neonatal Sepsis

Mode of Delivery and Asthma – Is There a Connection?

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