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Persistent pulmonary hypertension of the newborn following elective cesarean section in a community hospital

      Objective

      To evaluate the frequency of persistent pulmonary hypertension of the newborn (PPHN) following elective cesarean at greater that 34 weeks' gestation in an academically affiliated community hospital.

      Study design

      A retrospective chart review was conducted on 300 newborns diagnosed with PPHN at Miller Children's Hospital in Long Beach between January 1999 and June 2006. Maternal history, course of labor, route of delivery, and indications were abstracted from charts. Demographic data, gestational age, Apgar scores, and blood gas values were obtained from a neonatal outcomes database. Infants less than 34 weeks' gestation and with congenital diaphragmatic hernia were excluded from this review. Newborns were divided into three groups based on the mode of delivery: (1) Vaginal delivery referred to as spontaneous or assisted vaginal birth. (2) Cesarean delivery after a trial of labor was defined as a cesarean delivery after a failed trial of labor, whether spontaneous or induced. (3) Elective cesarean delivery was an abdominal delivery in absence of labor.

      Results

      Of the 219 neonates included, 73 were delivered vaginally, 92 were born by cesarean after an unsuccessful trial of labor, and 54 were products of elective cesarean deliveries. No statistically significant difference between neonatal groups in birth weight, gestational age, Apgar scores, or length of stay was noted. The incidence of PPHN following elective cesareans was 8.5 per 1000 deliveries (relative risk 3.4, 95% CI 2.4,4.8). In 2006, 35 neonates were diagnosed with PPHN and 49% were term products of elective cesareans.

      Conclusion

      Our findings include an unexpectedly high rate of PPHN, and suggest that community physicians should focus on decreasing the rate of elective cesareans. Furthermore, the findings have implications for increased vigilance in surveillance of these neonates following delivery.