Factors relating caesarean section to persistent pulmonary hypertension of the newborn
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Factors relating caesarean section to persistent pulmonary hypertension of the newborn Niralee Babooa, Wen-Jing Shi, Chao Chen Shanghai, China supplementation could potentially mitigate the effects of CS delivery and minimize CS-related PPHN.
Data sources: A literature search was conducted by electronic scanning of databases such as PubMed and Web of Science using the key words "persistent pulmonary hypertension of the newborn", "caesarean section", "iatrogenic prematurity", "oxidative stress", "late preterm", "labor" and "vasoactive agents".
Key words: caesarean section; iatrogenic prematurity; oxidative stress; persistent pulmonary hypertension of the newborn; vasoactive agents
Results: Iatrogenic prematurity, higher rates of late preterm delivery and lack of physiological changes of labor play an important role in the association between CS and PPHN. CS delivery also results in limited endogenous pulmonary vasodilator synthesis and lower levels of protective anti-oxidants in the neonates. In addition, CS delivery exposes infants to a higher risk of respiratory distress syndrome and its concomitant increase in endothelin-1 levels, which might indirectly lead to a higher risk of developing PPHN. We believe that neonates delivered by CS are exposed to a combination of these pathophysiological events, culminating in an endpoint of respiratory distress, hypoxia, acidosis, and delayed transition and thereby increased risks of PPHN. The use of antenatal corticosteroids prior to elective CS in late preterm deliveries, promoting accurate informedconsent process, delaying elective CS to 39 weeks of gestation or beyond and antenatal maternal anti-oxidant
Author Affiliations: Department of Neonatology, Children Hospital of Fudan University, Shanghai, China (Babooa N, Shi WJ, Chen C) Corresponding Author: Chao Chen, Department of Neonatology, Children Hospital of Fudan University, Shanghai 201102, China (Email: [email protected]) doi: 10.1007/s12519-017-0056-z ©Children's Hospital, Zhejiang University School of Medicine, China and Springer-Verlag Berlin Heidelberg 2017. All rights reserved.
Conclusions: The link between CS delivery and PPHN is complex. In view of the rising rates of CS worldwide, there is an urgent need to further explore the mechanisms linking CS to PPHN and experimentally test therapeutic options in order to allow effective targeted interventions. World J Pediatr 2017;13(6):517-527
Introduction
P
ersistent pulmonary hypertension of the newborn (PPHN), also known as "persistent fetal circulation", is defined as the failure of normal pulmonary vascular adaptation at or soon after birth, resulting in persistent high pulmonary vascular resistance (PVR) with diminished pulmonary blood flow and right to left shunting of unoxygenated blood to the systemic circulation through an open foramen ovale and/or a ductus arteriosus.[1] Numerous publications have reported higher rates of PPHN in neonates delivered by caesarean section (CS) compared to those born by vaginal delivery (VD). [2-7] Caesarean deliveries h
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