Making Small Risks Even Smaller  

Oleh:

Greene, Michael F.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 360 no. 02 (Jan. 2009), page 183-184.
Topik: Cesarean; hyaline membrane disease

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2009.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Cesarean sections performed without antecedent labor are associated with a higher risk of respiratory distress than those performed after the onset of labor, despite the fact that they may have been done at full term (at least 37 weeks of gestation). This respiratory distress is usually transient tachypnea of the newborn, which is generally milder in both severity and duration than respiratory distress syndrome due to hyaline membrane disease in premature babies. Unlike hyaline membrane disease, which results from a surfactant deficiency, transient tachypnea of the newborn results from delayed clearance of fetal alveolar fluid. The volume of fetal alveolar fluid decreases progressively but not linearly with advancing gestational age. In fetal guinea pigs, oxytocin-induced labor induces elevated levels of catecholamines, which stimulate ß-adrenergic sodium channels that clear fluid from fetal lung alveoli to permit gas exchange in the neonate. In this issue of the Journal, Tita et al.3 report the results of an observational study of 13,258 women with viable singleton pregnancies who underwent elective repeat cesarean section at term (37 weeks or greater) at 19 academic medical centers in the United States. The primary outcome was a composite measure of neonatal mortality and morbidity, which included respiratory distress syndrome, transient tachypnea of the newborn, hypoglycemia, newborn sepsis (suspected and proved), seizures, necrotizing enterocolitis, hypoxic–ischemic encephalopathy, cardiopulmonary resuscitation or ventilator support within 24 hours after birth, cord-blood arterial pH below 7.0, a 5-minute Apgar score of 3 or below, admission to the neonatal intensive care unit (ICU), and prolonged hospitalization (5 days or longer).

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