Download PDF
Am J Perinatol 2022; 39(11): 1254-1260
DOI: 10.1055/s-0040-1722603
Original Article

Association between Low Cord Serum Cortisol Level and Transient Tachypnea of the Newborn in Late Preterm and Term Neonates Delivered by Elective Cesarean Section

Raid M.R. Umran 
1   Department of Pediatrics, College of Medicine, University of Kufa, Al-Zahraa Teaching Hospital, Najaf Health Directorate, Najaf, Iraq
,
Roaa M. Khalil
2   Department of Pediatrics, Al-Zahraa Teaching Hospital, Najaf Health Directorate, Najaf, Iraq
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective Transient tachypnea of the newborn (TTN), a common neonatal respiratory morbidity, is associated with failure of adequate clearance of fetal lung fluid. Glucocorticoids have an important role in lung maturity and the mechanisms of lung fluid clearance. The aim of this study is to assess the association between umbilical cord cortisol levels and transient TTN in late preterm and term neonates delivered by elective cesarean section (CS).

Study Design A case-control study of 37 newborns diagnosed with TTN (cases) was compared with 40 healthy newborns (controls). All infants were delivered by elective CS without labor. Umbilical cord cortisol levels were measured using enzyme-linked immunosorbent assay.

Results Mean cord cortisol levels were significantly lower in cases than controls (131.36 vs. 233.32 nmol/L, p = 0.0001; odds ratio [OR] = 3.7; 95% confidence interval [CI]: 1.40–9.53), respectively. Cord serum cortisol correlated inversely with the duration of tachypnea and the respiratory rate (r =  − 0.678 and −0.535, respectively).

Conclusion Umbilical cord cortisol levels are significantly lower in newborns with transient TTN, and lower cortisol levels are associated with an increased respiratory rate and longer duration of admission. Antenatal glucocorticoids can be recommended for late preterm delivered by CS.

Key Points

  • Umbilical cord cortisol levels were lower in late preterm infants with TTN.

  • Late preterm newborn with severe TTN and NICU hospitalization have lower cord cortisol levels.

  • Antenatal glucocorticoids can be recommended for late preterm delivered by CS.

Keywords

cord cortisol - transient tachypnea of newborn - TTN - late preterm - elective cesarean section


Publication History

Received: 31 March 2020

Accepted: 04 December 2020

Article published online:
17 January 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Greenberg J, Naredran V, Schibler KR. et al. Neonatal morbidities of prenatal and perinatal origin. In: Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore TR. Creasy and Resnik's Maternal-Fetal Medicine: Principal and Practice. 6th ed.. Philadelphia, PA: Elsevier; 2009: 1197-1228
    Google Scholar
  • 2 Kiensta KA. Transient Tachypnea of Newborn. In: Cloherty JP, Eichnwald EC, Hansen AR, Stark AR. eds. Manual of Neonatal Care. 7th ed.. Philadelphia, PA: Elsevier; 2012: 364
    Google Scholar
  • 3 Elias N, O'Brodovich H. Clearance of fluid from airspaces of newborns and infants. Neoreviews 2006; 7: e88
    CrossrefPubMedGoogle Scholar
  • 4 Greenough A, Milner AD. Neonatal Respiratory Disorders. 2nd ed.. London, United Kingdom: Arnold; 2003: 272
    CrossrefGoogle Scholar
  • 5 The respiratory system. In: Martin RJ, Fanaroff AA, Walsh MC. eds. Neonatal-Perinatal Medicine. 9th ed.. Philadelphia, PA: Elsevier; 2011: 1075-1206
    Google Scholar
  • 6 Pillow JJ, Jobe AH. Respiratory disorders of the newborn. In: Taussing LM, Landau LI, Souef PNL, Morgan WJ, Martinez FD, Sly PD. eds. Pediatric Respiratory Medicine. 2nd ed.. Philadelphia, PA: Elsiever; 2008: 365-386
    Google Scholar
  • 7 Martin RJ, Crowley MA. Respiratory problems. In: Fanaroff AA, Fanaroff JM. eds. Klaus and Fanaroff's Care of the High-Risk Neonate. 6th ed.. Philadelphia, PA: Elsiever; 2013: 244-269
    Google Scholar
  • 8 Welty S, Hansen TN, Corbet A. Respiratory distress in preterm infant. In: Taeusch HW, Ballard RA, Gleason CA. eds. Avery's Diseases of the Newborn. 8th ed.. Philadelphia, PA: Elsiver; 2005: 687-704
    Google Scholar
  • 9 Martin RJ, Kohn A. Pulmonary hemorrhage, transient tachypnea, and neonatal pneumonia. In: Buonocore G, Bracci R, Weindeling M. eds. Neonatology: A Practical Approach to Neonatal Management. Springer; 2012: 455-459
    Google Scholar
  • 10 Jain L, Eaton DC. Physiology of fetal lung fluid clearance and the effect of labor. Semin Perinatol 2006; 30 (01) 34-43
    CrossrefPubMedGoogle Scholar
  • 11 Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; 3 (03) CD004454
    PubMedGoogle Scholar
  • 12 Travers CP, Clark RH, Spitzer AR, Das A, Garite TJ, Carlo WA. Exposure to any antenatal corticosteroids and outcomes in preterm infants by gestational age: prospective cohort study. BMJ 2017; 356: j1039
    Google Scholar
  • 13 Jain L, Dudell GG. Respiratory transition in infants delivered by cesarean section. Semin Perinatol 2006; 30 (05) 296-304
    CrossrefPubMedGoogle Scholar
  • 14 Liu G, Segrè J, Gülmezoglu A. et al. Antenatal corticosteroids for management of preterm birth: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy Childbirth 2015; 15 Suppl 2 (Suppl. 02) S3
    CrossrefPubMedGoogle Scholar
  • 15 Tsuda H, Kotani T, Sumigama S, Mano Y, Hua L, Kikkawa F. Impact of warning bleeding on the cortisol level in the fetus and neonatal RDS/TTN in cases of placenta previa. J Matern Fetal Neonatal Med 2015; 28 (09) 1057-1060
    CrossrefPubMedGoogle Scholar
  • 16 Atasay B, Ergun H, Okulu E, Mungan Akın I, Arsan S. The association between cord hormones and transient tachypnea of newborn in late preterm and term neonates who were delivered by cesarean section. J Matern Fetal Neonatal Med 2013; 26 (09) 877-880
    CrossrefPubMedGoogle Scholar
  • 17 Tsuda H, Kotani T, Sumigama S. et al. Relationship between the cortisol levels in umbilical cord blood and neonatal RDS/TTN in twin pregnancies. J Matern Fetal Neonatal Med 2016; 29 (13) 2151-2156
    CrossrefPubMedGoogle Scholar
  • 18 Katz C, Bentur L, Elias N. Clinical implication of lung fluid balance in the perinatal period. J Perinatol 2011; 31 (04) 230-235
    CrossrefPubMedGoogle Scholar
  • 19 Gyamfi-Bannerman C, Thom EA, Blackwell SC. et al; NICHD Maternal–Fetal Medicine Units Network. Antenatal Betamethasone for Women at Risk for Late Preterm Delivery. N Engl J Med 2016; 374 (14) 1311-1320
    CrossrefPubMedGoogle Scholar
  • 20 Stutchfield B, Whitaker R, Russell I. Antenatal Steroids for Term Elective Caesarean Section (ASTECS) Research Team. Antenatal betamethasone and incidence of neonatal respiratory distress after elective cesarean section. BMJ 2005; 331 (7518): 662
    CrossrefPubMedGoogle Scholar
  • 21 Yinon Y, Haas J, Mazaki-Tovi S. et al. Should patients with documented fetal lung immaturity after 34 weeks of gestation be treated with steroids?. Am J Obstet Gynecol 2012; 207 (03) 222.e1-222.e4
    CrossrefPubMedGoogle Scholar
  • 22 Bagnoli F, Mori A, Fommei C, Coriolani G, Badii S, Tomasini B. ACTH and cortisol cord plasma concentrations in preterm and term infants. J Perinatol 2013; 33 (07) 520-524
    CrossrefPubMedGoogle Scholar
  • 23 Machado LU, Fiori HH, Baldisserotto M, Ramos Garcia PC, Vieira AC, Fiori RM. Surfactant deficiency in transient tachypnea of the newborn. J Pediatr 2011; 159 (05) 750-754
    CrossrefPubMedGoogle Scholar
  • 24 James DK, Chiswick ML, Harkes A, Williams M, Hallworth J. Non-specificity of surfactant deficiency in neonatal respiratory disorders. Br Med J (Clin Res Ed) 1984; 288 (6431): 1635-1638
    CrossrefPubMedGoogle Scholar
  • 25 Staub NC. Effects of alveolar surface tension on the pulmonary vascular bed. Jpn Heart J 1966; 7 (04) 386-399
    CrossrefPubMedGoogle Scholar
  • 26 Gowen Jr. CW, Lawson EE, Gingras J, Boucher RC, Gatzy JT, Knowles MR. Electrical potential difference and ion transport across nasal epithelium of term neonates: correlation with mode of delivery, transient tachypnea of the newborn, and respiratory rate. J Pediatr 1988; 113 (1, pt 1): 121-127
    CrossrefPubMedGoogle Scholar
  • 27 Helve O, Pitkänen O, Janér C, Andersson S. Pulmonary fluid balance in the human newborn infant. Neonatology 2009; 95 (04) 347-352
    CrossrefPubMedGoogle Scholar
  • 28 Stutchfield P, Whitaker R, Russell I. Antenatal Steroids for Term Elective Caesarean Section (ASTECS) Research Team. Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomised trial. BMJ 2005; 331 (7518): 662
    CrossrefPubMedGoogle Scholar
  • 29 American College of Obstetricians and Gynecologists' Committee on Obstetric Practice, Society for Maternal– Fetal Medicine. Committee Opinion No.677: Antenatal Corticosteroid Therapy for Fetal Maturation. Obstet Gynecol 2016; 128 (04) e187-e194
    CrossrefPubMedGoogle Scholar
  • 30 Brownfoot FC, Gagliardi DI, Bain E, Middleton P, Crowther CA. Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2013; 8 (08) CD006764
    PubMedGoogle Scholar
  • 31 Saccone G, Berghella V. Antenatal corticosteroids for maturity of term or near term fetuses: systematic review and meta-analysis of randomized controlled trials. BMJ 2016; 355: i5044
    CrossrefPubMedGoogle Scholar
  • 32 Prefumo F, Ferrazzi E, Di Tommaso M. et al. Neonatal morbidity after cesarean section before labor at 34(+0) to 38(+6) weeks: a cohort study. J Matern Fetal Neonatal Med 2016; 29 (08) 1334-1338
    CrossrefPubMedGoogle Scholar
  • 33 Zanardo V, Simbi AK, Franzoi M, Soldà G, Salvadori A, Trevisanuto D. Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery. Acta Paediatr 2004; 93 (05) 643-647
    CrossrefPubMedGoogle Scholar
  • 34 Berger PJ, Smolich JJ, Ramsden CA, Walker AM. Effect of lung liquid volume on respiratory performance after caesarean delivery in the lamb. J Physiol 1996; 492 (pt 3): 905-912
    CrossrefPubMedGoogle Scholar
  • 35 Irestedt L, Lagercrantz H, Belfrage P. Causes and consequences of maternal and fetal sympathoadrenal activation during parturition. Acta Obstet Gynecol Scand Suppl 1984; 118: 111-115
    CrossrefPubMedGoogle Scholar
  • 36 Riley CA, Boozer K, King TL. Antenatal corticosteroids at the beginning of the 21st century. J Midwifery Womens Health 2011; 56 (06) 591-597
    CrossrefPubMedGoogle Scholar
  • 37 Ramachandrappa A, Jain L. Elective cesarean section: its impact on neonatal respiratory outcome. Clin Perinatol 2008; 35 (02) 373-393 , vii
    CrossrefPubMedGoogle Scholar
  • 38 Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis JP, McGoldrick E. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database Syst Rev 2018; 8 (08) CD006614
    CrossrefPubMedGoogle Scholar