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      The effects of delivery type and gender on intraocular pressure and central corneal thickness in newborns Translated title: Os efeitos do tipo de parto e sexo sobre a pressão intraocular e espessura corneana central em recém-nascidos

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          Abstract

          ABSTRACT Purpose: To analyze intraocular pressure (IOP) and central corneal thickness (CCT) in newborns during the first 12 h of life. Methods: Forty-three newborns born by vaginal delivery (VD) and 30 newborns born by cesarean section (CS) were evaluated. IOP and CCT were measured using Tono-Pen and handheld pachymeter, respectively, at both the 5th minute after delivery and at the 12th h of life. Results: The mean IOP for the VD group was significantly higher than that of the CS group at both the 5th minute and 12th h (p =0.042 and p =0.018, respectively). In both groups, the IOP decreased by the 12th h, but the decrease was only significant for the CS group (p =0.020). The decrease in CCT over the 12 h was significant for both groups (p <0.001). In the VD and CS groups, the IOP values of the males were significantly higher than those of the females at the fifth minute only (p =0.024 and p =0.043, respectively). No other values were significantly different between the genders. Conclusions: Newborn IOP is affected by the mode of delivery and gender. A higher IOP was found in vaginally delivered newborns than in CS newborns for at least 12 h postpartum. CCT showed a significant decline within 12 h. Male newborns have significantly higher IOP values in the first minutes of life.

          Translated abstract

          RESUMO Objetivos: Analisar a pressão intraocular (IOP) e a espessura corneana central (CCT) em recém-nascidos durante as primeiras 12 horas de vida. Método: Quarenta e três recém-nascidos nascidos por parto vaginal (VD) e 30 recém-nascidos nascidos após cesariana (CS) foram avaliados. IOP e CCT foram medidos com Tono-Pen e Handheld Pachymeter no quinto minuto após o parto e na décima segunda hora de vida. Resultados: A média de IOP para o grupo VD foi significativamente maior do que o grupo CS tanto no quinto minuto quanto na décima segunda hora (p=0,042, p=0,018, respectivamente). Em ambos os grupos, a IOP diminuiu na décima segunda hora, mas a redução foi significativa apenas para o grupo CS (p=0,020). A diminuição da CCT nas doze horas foi significativa para ambos os grupos (p<0,001). Nos grupos VD e CS os valores de IOP dos homens foram significativamente maiores do que das mulheres apenas no quinto minuto (p=0,024 e p=0,043, respectivamente). Outros valores não foram significativamente diferentes entre os sexos. Conclusões: A IOP em recém-nascidos é afetada pela via de parto e pelo sexo. A IOP é maior em recém-nascidos de parto normal durante pelo menos 12 horas. A CCT mostra queda significativa no prazo de 12 horas. Recém-nascidos do sexo masculino têm valores de IOP significativamente mais elevados nos primeiros minutos de vida.

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          Physiology of fetal lung fluid clearance and the effect of labor.

          Respiratory morbidity in near term (> or =34 and <37 weeks) infants delivered spontaneously or by elective cesarean section (ECS) has been well documented in the literature, and accounts for a significant number of admissions to intensive care units among these neonates. Given the high rates of near-term deliveries in the USA and worldwide, the public health and economic impact of morbidity in this subgroup is considerable. Causes of respiratory distress include transient tachypnea of the newborn (TTNB), surfactant deficiency, pneumonia, and pulmonary hypertension. There is considerable evidence that physiologic events in the last few weeks of pregnancy coupled with the onset of spontaneous labor are accompanied by changes in the hormonal milieu of the fetus and its mother, resulting in rapid maturation and preparation of the fetus for delivery and neonatal transition. A surge in endogenous steroids and catecholamines accompanies term gestation and spontaneous vaginal delivery, and is responsible for some of the maturational effects. Rapid clearance of fetal lung fluid clearance plays a key role in the transition to air breathing. The bulk of this fluid clearance is mediated by transepithelial sodium reabsorption through amiloride-sensitive sodium channels in the alveolar epithelial cells with only a limited contribution from mechanical factors and Starling forces. Disruption of this process can lead to retention of fluid in air spaces, setting the stage for alveolar hypoventilation. When infants are delivered near-term, especially by cesarean section (repeat or primary) before the onset of spontaneous labor, the fetus is often deprived of these hormonal changes, making the neonatal transition more difficult. This chapter discusses the physiologic mechanisms underlying fetal lung fluid absorption and explores potential strategies for facilitating neonatal transition.
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            Changes in heart rate in the first minutes after birth.

            The normal range of heart rate (HR) in the first minutes after birth has not been defined. Objective To describe the HR changes of healthy newborn infants in the delivery room (DR) detected by pulse oximetry. Study Design All inborn infants were eligible and included if a member of the research team attended the birth. Infants were excluded if they received any form of medical intervention in the DR including supplemental oxygen, or respiratory support. HR was measured using a pulse oximeter (PO) with the sensor applied to the right hand or wrist immediately after birth. PO data (oxygen saturation, HR and signal quality) were downloaded every 2 sec and analysed only when the signal had no alarm messages (low IQ signal, low perfusion, sensor off, ambient light). Results Data from 468 infants with 61 650 data points were included. Infants had a mean (range) gestational age of 38 (25-42) weeks and birth weight 2970 (625-5135) g. At 1 min the median (IQR) HR was 96 (65-127) beats per min (bpm) rising at 2 min and 5 min to 139 (110-166) bpm and 163 (146-175) bpm respectively. In preterm infants, the HR rose more slowly than term infants. Conclusions The median HR was <100 bpm at 1 min after birth. After 2 min it was uncommon to have a HR <100 bpm. In preterm infants and those born by caesarean section the HR rose more slowly than term vaginal births.
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              Mode of delivery is associated with maternal and fetal endocrine stress response.

              To determine whether mode of delivery is associated with the endocrine stress response in mother and child. Prospective observational study. Tertiary care centre, University hospital. A total of 103 nulliparous women with uncomplicated singleton pregnancies at term undergoing either spontaneous labour for vaginal delivery or delivering by caesarean section without labour. Thirty women delivered vaginally without any pain relief, 21 women delivered vaginally with epidural anaesthesia, 23 women had ventouse extraction and 29 women underwent caesarean section with epidural analgesia. After delivery, maternal and umbilical cord blood was collected for determination of different stress-associated hormones. Concentrations of epinephrine (EP), norepinephrine (NOR), adrenocorticotropic hormone (ACTH), cortisol (CORT), prolactin (PRL), corticotropin-releasing factor and beta-endorphin (BE). Caesarean section was associated with significantly lower maternal concentrations of EP, NOR, ACTH, CORT, PRL and BE and lower newborn levels of EP, NOR and CORT compared with all other modes of delivery. Concentrations of EP, ACTH and BE differed significantly in newborns delivered by normal vaginal delivery, vaginal delivery with epidural anaesthesia and ventouse extraction. The mode of delivery and analgesia used during birth are associated with maternal and fetal endocrine stress responses.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                abo
                Arquivos Brasileiros de Oftalmologia
                Arq. Bras. Oftalmol.
                Conselho Brasileiro de Oftalmologia
                1678-2925
                April 2016
                : 79
                : 2
                : 92-95
                Affiliations
                [1 ] Dicle University Turkey
                [2 ] Diyarbakir Education and Research Hospital Turkey
                [3 ] Diyarbakir Women's and Children's Diseases Hospital Turkey
                [4 ] Trakya University of Medicine Turkey
                Article
                S0004-27492016000200092
                10.5935/0004-2749.20160028
                27224071
                d7e08c8b-27f9-47df-a0fc-fde41871ebb6

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0004-2749&lng=en
                Categories
                OPHTHALMOLOGY

                Ophthalmology & Optometry
                Cesárea,Parto obstétrico,Pressão intraocular,Córnea/anatomia & histologia,Recém-nascido,Cesarean section,Delivery, obstetric,Intraocular pressure,Cornea/anatomy & histology,Infant,Newborn

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