1. PROLONGED AFTER BIRTH ADAPTATION OF NEWBORN – RISK FACTORS
Milas V1,2,3, Dobrić H1,2, Milas K1,2, Šapina M1,2,3
1 Neonatology intensive care unit, Clinical hospital Osijek
2 Medical faculty of Josip Juraj Strossmayer University Osijek
3 Faculty of dental medicine and health care of Josip Juraj Strossmayer University Osijek
Table 2. Symptoms, duration of oxygen therapy and hospitalization of newborns with prolonged after birth adaptation
INTRODUCTION
Adaptation of the neonate after the delivery occurs through many processes. Many factors have been reported to initiate breathing (umbilical cord occlusion, somatic stimulation, hyperoxia and coetaneous cooling). The benefits of labor augmentation and induction may increase the likelihood of neonatal complications or may lead in unnecessary caesarean section. Augmentation of labor can be necessary when there is a failure of cervical dilatation or fetal descent with spontaneous uterine contractions. Induction of labor has several medical indications (diabetes, premature rupture of membranes after 34 weeks, post-term pregnancies and related hypertension, as well as intrauterine growth restriction). The way of delivery plays an important role in the after birth adaptation.
Symptoms
N %
N % deliveries p
Plethora
39 (65.0)
p<0.05
Respiratory distress
15 (25.0)
Cyanotic crisis
19 (31.7)
Dystony, irritability
5 (8.3)
Jaundice
19 (31.7)
Bradikardia
8 (13.3)
Up to 5 days
32 (53.3)
Need for oxygen
days
17 (28.3)
days
3 (18.4)
4 (6,7)
Hospitalization
36 (60.0)
20 (33.3)
Spontaneously
838 (1.8)
Mode of delivery
Induction or augmentation
30 (50.0)
547 (5.5)
Caesarean section
619 (2.4)
p>0.05
METHODS
A retrospective study included 60 neonates with prolonged after birth adaptation as the only diagnose for admission in the Neonatal intensive care unit in one year. The following parameters were analyzed: mother’s chronic (hypertension, diabetes mellitus, hypothyroidism, infections) and acute illnesses connected with pregnancy (gestational diabetes mellitus, preeclampsia), other chronic mothers illnesses, previous complicated pregnancies (IVF or abortions), complications during labor (with umbilical cord, color of amniotic fluid), gender of the neonate, birth weight, order of pregnancy, duration of oxygen therapy and length of the hospitalization. Clinical features of newborns were analyzed and described. Statistical analysis was performed, along with the chosen level of significance of p=0.05. Comparison of variables was tested by X2 test with Yates’s correction.
Mode of delivery has been found as an important factor in the newborns after birth adaptation (p<0.05). The risk for those born spontaneously or by caesarean section has been almost equal and low, and bigger for those born with augmentation and induction of labor. The main symptoms among affected were: plethora (the oftenest symptom, happened more often than others – p< 0.05), cyanotic crises, dystony, irritability, jaundice, bradicardia and respiratory distress. Newborns with plethora (83, 3%) needed oxygen in the prolonged period (majority of them for 6 to 10 days – p<0.05). Most of them were hospitalized for 6 – 10 days (p<0.05).
RESULTS
Table 1. Characteristics of neonates with prolonged after birth adaptation
CONCLUSION
Newborns with PA
N (%)
Live born % p
Gender
Male
38 (63.3)
1004
0.8
p<0.05
Female
22 (36.7)
1029
0.2
Birth weight
Hypotrophic
9 (15.0) 85
10.6
Eutrophic
42 (70.0)
1867
2.2
Hypertrophic 81
11.1
Total number of neonates admitted to NICU
60 (100)
2033 3
Admitted to NICU
228 (100)
26.3
Labor
First
23 (38.3)
911
2.5
p>0.05
Second
25 (41.7)
691
3.6
Third and more
12 (20.0)
402
Sustained pregnancies
7 (11.7)
Mothers chronic illnesses
13 (21.7)
Green amniotic fluid
5 (8.2)
Problems with umbilical cord
10 (16.7)
N with complications
35 (58.3)
N without complications
Number of deliveries in 2016
2004
Mode of delivery is connected with newborns after birth adaptation. Inducted or augmentated labor can cause intrauterine hypoxia and provocate plethora as a self defending mechanism. It can cause higher vascular resistance and blood pressure. Those can stimulate bar receptors in blood vessels and glomus caroticus and cause bradicardia of the neonate. The newborn can be irritable with oscillating tonus. He/she can have jaundice and cyanotic crises (as a result of plethora) or can develop respiratory distress. Oxygen must be introduced. These neonates needs longer period of hospitalization. Additional risk factors for prolonged adaptation are male gender and low and high weight for gestation.
Prolonged after birth adaptation had 26, 3% of all admitted neonates in the NICU in one year, and 3% among all live born neonates. The proportion is 4 times higher in male newborns. Hypo and hypertrophic newborns were in the higher risk. Order of pregnancy has not been a risk factor (p<0.05). Differences have not been found between newborns with and without mother’s complications during pregnancy and labor.