Hospitalisation for bronchiolitis in infants is more common after elective caesarean delivery
Hannah C Moore1, Nicholas de Klerk, Patrick Holt
1Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia. hannahm@ichr.uwa.edu.au
Insights
Elective cesarean delivery increases infant bronchiolitis risk, but not pneumonia. This suggests potential impacts on newborn immunity from delivery without labor, warranting further investigation into early respiratory infections.
Area of Science:
- Obstetrics and Gynecology
- Pediatrics
- Epidemiology
Background:
- Previous research indicated a higher risk of lower respiratory infections in children born via elective cesarean.
- Rising rates of elective cesarean deliveries necessitate further examination of associated infant health outcomes.
Purpose of the Study:
- To investigate the relationship between elective cesarean delivery and hospital admissions for bronchiolitis and pneumonia in infants.
- To assess if the mode of delivery impacts the risk of specific respiratory infections in early childhood.
Main Methods:
- A retrospective, population-based cohort study included 212,068 non-Aboriginal singleton births (37-42 weeks gestation).
- Negative binomial regression analysis was employed to examine associations, adjusting for obstetric and known risk factors.
- Hospital admissions for bronchiolitis and pneumonia were analyzed for infants <12 months and 12-23 months.
Main Results:
- Elective cesarean delivery (16% of births) was associated with an increased risk of bronchiolitis admissions in infants <12 months (IRR 1.11) and 12-23 months (IRR 1.20).
- No significant association was found between elective cesarean delivery and hospital admissions for pneumonia in either age group.
- These associations remained significant after adjusting for maternal and fetal factors.
Conclusions:
- Elective cesarean delivery is independently linked to increased infant hospital admissions for bronchiolitis.
- The findings suggest that delivery without labor may compromise newborn immunity, elevating the risk of early viral respiratory infections.
- Further research is needed to understand the mechanisms behind this association and its implications for infant health.
Background:
The authors previously reported an increased risk of hospitalisation for acute lower respiratory infection up to age 2 years in children delivered by elective caesarean section. In view of increasing rates of elective caesarean delivery, this association warranted further investigation.
Objective:
To examine associations between the number of hospital admissions for bronchiolitis and pneumonia and elective caesarean delivery.
Design:
Retrospective population-based data linkage cohort study of 212 068 non-Aboriginal singleton births of 37-42 weeks gestation.
Methods:
Negative binomial regression was used to examine associations between mode of delivery and hospitalisations for both bronchiolitis and pneumonia in children aged <12 months and 12-23 months. Models were adjusted for obstetric and known risk factors.
Results:
16% of children were delivered by elective caesarean section (n=33 421). In adjusted analysis, compared with spontaneous vaginal delivery, these children had increased risk of admissions for bronchiolitis at age <12 months (incidence rate ratio (IRR) 1.11; 95% CI 1.01 to 1.23) and 12-23 months (IRR 1.20; 95% CI 0.94 to 1.53) independent of other fetal and maternal factors. There was no association between elective caesarean delivery and number of pneumonia admissions aged <12 months (IRR 1.03; 95% CI 0.80 to 1.33) and 12-23 months (IRR 1.09; 95% CI 0.88 to 1.34).
Conclusion:
Delivery by elective caesarean was independently associated with infant admissions for bronchiolitis but not pneumonia. Elective caesareans or delivery without labour may result in impaired immunity in the newborn leading to increased risk of early viral lower respiratory infections.
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