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Elective cesarean increases risk for infant breathing problems

Transient tachypnea of the newborn (TTN) is a common cause of respiratory problems in infants. A recent study published in Pediatrics finds that babies born by cesarean without experiencing labor are at substantially greater risk for developing TTN.

The researchers examined the incidence of TTN among babies who experienced labor and those who did not. Babies delivered by elective cesarean (ECS) at 37 weeks gestation had a nearly 5 times the risk on average of developing TTN compared to those who experienced labor. The relative risk of TTN decreased as gestational age (GA) increased, but even at term (40 weeks), infants delivered by cesarean with no experience of labor had two times the risk of having TTN.

According to the authors (emphasis added):

The main finding of the present study is that the mode of birth and the absence of labor are strongly related to the development of TTN in newborns, irrespective of GA, even at term. Our analyses  are  in  good  accordance with previous  data  indicating  ECS, low GA, male gender, and inappropriate birth weight as main risk factors for TTN. Furthermore, the presence of labor before birth was shown to improve respiratory outcomes for infants with TTN. To the best of our knowledge, this is the first study to demonstrate that not only the presence or absence but also the duration of labor before birth positively influences the course of TTN, with a shorter need for supplemental oxygen therapy. No correlations with other outcome variables were found. Our results clearly indicate ECS as the main risk factor for TTN and the crucial role of labor in respiratory outcomes in TTN.