Regional Lung Aeration and Ventilation Characteristics in Newborn Infants after Cesarean and Spontaneous Delivery

Introduction Infants born by cesarean section are at increased risk of respiratory distress compared with spontaneously delivered infants. Previous research has explored various differences between these groups, but no studies have used electrical impedance tomography (EIT) to assess differences in regional ventilation and aeration distribution within the lungs on a beath-by-breath basis. This study aimed to compare the ventilation and aeration characteristics during postnatal adaptation of cesarean and spontaneously delivered infants using EIT.

Methods We conducted a single-center, retrospective post hoc analysis of data from two prospective observational studies. EIT measurements were recorded from birth, and 20 second segments were extracted each minute for the first 10 minutes of life. We compared tidal volumes, indicators of ventilation homogeneity – including the coefficient of variation (CV) and center of ventilation (CoV) – and end-expiratory lung impedance (EELI) as a proxy for end-expiratory lung volume between the two groups [1] [2] [3].

Results: Of 87 term infants without respiratory support, 46 (53%) were delivered spontaneously and 41 (47%) via primary cesarean delivery. Analysis of 15’262 manually selected breaths showed that spontaneously delivered infants had higher tidal volumes and more homogeneous ventilation, especially in the first minutes of life (p<0.001). CV decreased over time in both groups (p<0.001). In both groups, the tidal ventilation was distributed more dorsally with an increasingly dorsal center of ventilation over time in spontaneously born infants (p<0.001). End-expiratory lung volumes increased in both groups, with a smaller rise in the spontaneous born infants (p=0.03). Spontaneously born infants had an overall lower respiratory rate (p<0.001).

Conclusion: We found significant differences in respiratory transition between spontaneously born and cesarean section delivered infants. Following spontaneous birth, infants generated higher tidal volumes, potentially due to the endogenous surge of steroids and catecholamines. This may facilitate lung liquid clearance, leading to more homogeneous ventilation patterns after birth compared to cesarean delivered infants.

Publication History

Article published online:
19 May 2025

• Literatur

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