Journal: Pediatr Crit Care Med 9(2):203-208, 2008
Reprint: Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
Faculty Disclosure: Abstracted by T. Tilton, who has nothing to disclose.
Evidence suggests that respiratory distress syndrome and transient tachypnea in newborns is related to elective cesarean section (ECS). Pulse oximeter perfusion index (PI) has been linked to increased illness severity and outcome in both newborns and adults. Early PI monitoring has been helpful in identifying histologic chorioamnionitis (HCA) in term newborns. This study assessed the value of maternal PI, pulse rate, and oximetry (SpO2) during ECS and tested the hypothesis that a low maternal PI in the preanesthesia period of ECS is a predictor of early adverse neonatal respiratory outcome.
Forty-four healthy women, mean age 33.19±4.71 yr, undergoing ECS were included in a prospective, cohort study. Indications for ECS included previous CS (n=22); maternal request (3); significant maternal prior retinal detachment (1); low-lying placenta with vasa previa (2); velamentous insertion of the umbilical cord (1); and breech presentation (15). Anesthetic techniques were general, spinal, or combined spinal/epidural.
Six infants (13.6%) showed early respiratory compli¬cations (5 with transient tachypnea of the newborn and 1 with respiratory distress syndrome). Subclinical HCA was found in 4 newborns (1 with clinical sepsis; 2 with fetal vasculitis). Total length of stay was significantly longer (almost twice as long as the controls). The mothers of these newborns showed significantly decreased PI and SpO2 and increased pulse rate, SBP, and DBP compared to mothers with normal neonatal outcomes. Mothers with a PI ≤ 1.9 (lower quartile = 1.48, 95% CI 1.3-1.9) during pre¬anesthesia had significantly poorer blood gas results and their newborns had a higher frequency of early respiratory complications, subclinical HCA, and funisitis, higher indexes of clinical severity and thera¬peutic intensity; higher core temperature; and signifi¬cantly lower average cord blood PO2/SpO2 compared to infants whose mothers had normal PIs.
A decreased PI during the preanesthesia phase of ECS is a maternal predictor of increased neonatal morbidity and is significantly related to subclinical placental inflammatory disease. A low maternal PI may be indicative of pathologic stress in fetoplacental blood flow. |
