The influence of route of delivery on neonatal respiratory distress syndrome: an integrative review
DOI:
https://doi.org/10.62827/fb.v26i3.1065Keywords:
Respiratory Distress Syndrome; Cesarean Section; Natural Childbirth.Abstract
Introduction: Neonatal respiratory distress syndrome is an important cause of perinatal morbidity and mortality. Route of delivery is one of the possible influencing factors of this syndrome. Objective: Evidence on the association between route of delivery and neonatal respiratory distress syndrome were summarized. Methods: For this integrative review, observational studies published between 2013 and 2023 were searched in the databases Latin American and Caribbean Health Sciences Literature (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) and american service of the National Library of Medicine for free access to MEDLINE (PubMed). Results: caesarean section increased the risk of respiratory distress syndrome in 9 of the 12 studies included in this review, while vaginal delivery caused this effect in 1 study. Conclusion: much of the evidence pointed to caesarean section as a risk factor for respiratory distress syndrome. If corroborated by further research, this result could help to ensure that vaginal delivery is, in fact, a preventative measure for neonatal respiratory distress syndrome.
References
Claireaux Albert E. HYALINE MEMBRANE IN THE NEONATAL LUNG. The Lancet [Internet]. 1953 Oct;262(6789):749–53. Available from: http://dx.doi.org/10.1016/s0140-6736(53)91451-2.
Hermansen CL, Mahajan A. Newborn Respiratory Distress. American Family Physician [PubMed]. 2015 Dec 1;92(11):994–1002. Available from: https://pubmed.ncbi.nlm.nih.gov/26760414/.
Rubarth LB, Quinn J. Respiratory Development and Respiratory Distress Syndrome. Neonatal Network [Internet]. 2015;34(4):231–8. Available from: http://dx.doi.org/10.1891/0730-0832.34.4.231.
Mohy Eldeen S, Ali S, Salama H. Clinical characteristics, diagnosis, and management outcome of surfactant deficiency respiratory distress syndrome in term and near-term neonates. A retrospective observational study. Acta Bio Medica: Atenei Parmensis [PubMed Central]. 2022 Dec 16;93(6):e2022337. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9828914/.
Sweet DG, Carnielli VP, Greisen G, Hallman M, Klebermass-Schrehof K, Ozek E, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology [Internet]. 2023;120(1):3–23. Available from: http://dx.doi.org/10.1159/000528914.
Yarbrough ML, Grenache DG, Gronowski AM. Fetal Lung Maturity Testing: The End of an Era. Biomarkers in Medicine [Internet]. 2014 Apr;8(4):509–15. Available from: http://dx.doi.org/10.2217/bmm.14.7.
Correa J, Couri LM, Soares JL. Conceitos atuais sobre avaliação da maturidade pulmonar fetal. Femina: Femina: revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia. [Internet] 2014 Jan 1;42(3):141–8. Available from: https://www.febrasgo.org.br/media/k2/attachments/Femina_v42n3.pdf.
Santana SMP de, Novais MAP de, Zucchi P. Internações Hospitalares de Neonatos com Síndrome do Desconforto Respiratório e sua Participação nas Internações Hospitalares Neonatais no Âmbito do Sistema Único de Saúde em 2015. International Journal of Health Management Review [Internet]. 2016 Jun 1;2(1):1–18. Available from: http://dx.doi.org/10.21902/jhmreview.v2i1.321.
Prestes D, Antunes V da P, Cardoso DM, Bajotto AP, Pasqualoto AS. CARACTERÍSTICAS DE NEONATOS COM SÍNDROME DO DESCONFORTO RESPIRATÓRIO CONSIDERANDO A VIA DE PARTO EM UMA UNIDADE DE TERAPIA INTENSIVA DA REGIÃO CENTRAL DO RS. Revista Brasileira de Ciências da Saúde [Internet]. 2019 Oct 1;23(3): 393-8. Available from: http://dx.doi.org/10.22478/ufpb.2317-6032.2019v23n3.36947.
Wang J, Liu X, Zhu T, Yan C. Analysis of neonatal respiratory distress syndrome among different gestational segments. International journal of clinical and experimental medicine [PubMed Central]. 2015 Jan 1;8(9):16273–9. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4659032/.
Baseer KAA, Mohamed M, Abd-Elmawgood EA. Risk Factors of Respiratory Diseases Among Neonates in Neonatal Intensive Care Unit of Qena University Hospital, Egypt. Annals of Global Health [Internet]. 2020;86(1): 1-9. Available from: http://dx.doi.org/10.5334/aogh.2739.
Mukosha M, Jacobs C, Kaonga P, Musonda P, Vwalika B, Lubeya MK, et al. Determinants and Outcomes of Low Birth Weight among Newborns at a Tertiary Hospital in Zambia. Annals of African Medicine [Internet]. 2023 Jul;22(3):271–8. Available from: http://dx.doi.org/10.4103/aam.aam_22_22.
Su Z, Lin L, Fan X, Jia C, Shi B, Huang X, et al. Increased Risk for Respiratory Complications in Male Extremely Preterm Infants: A Propensity Score Matching Study. Frontiers in Endocrinology [Internet]. 2022 May 12;13. Available from: http://dx.doi.org/10.3389/fendo.2022.823707.
Yang M, Fang L, Wang Y, Li X, Cao Y, Sun J, et al. Perinatal characteristics and neonatal outcomes of singletons and twins in Chinese very preterm infants: a cohort study. BMC Pregnancy and Childbirth [Internet]. 2023 Feb 1;23(1). Available from: http://dx.doi.org/10.1186/s12884-023-05409-8.
Mortier I, Blanc J, Tosello B, Gire C, Bretelle F, Carcopino X. Is gestational diabetes an independent risk factor of neonatal severe respiratory distress syndrome after 34 weeks of gestation? A prospective study. Archives of Gynecology and Obstetrics [Internet]. 2017 Sep 25;296(6):1071–7. Available from: http://dx.doi.org/10.1007/s00404-017-4505-7.
Werner EF, Han CS, Savitz DA, Goldshore M, Lipkind HS. Health Outcomes for Vaginal Compared With Cesarean Delivery of Appropriately Grown Preterm Neonates. Obstetrics & Gynecology [Internet]. 2013 Jun;121(6):1195–200. Available from: http://dx.doi.org/10.1097/aog.0b013e3182918a7e.
Offermann H, Gebauer C, Pulzer F, Bläser A, Thome U, Knüpfer M. Cesarean section increases the risk of respiratory adaptive disorders in healthy late preterm and two groups of mature newborns. Zeitschrift für Geburtshilfe und Neonatologie [Internet]. 2015 Jul 7;219(06):259–65. Available from: http://dx.doi.org/10.1055/s-0035-1545323.
Kim JH, Lee SM, Lee YH. Risk factors for respiratory distress syndrome in full-term neonates. Yeungnam University Journal of Medicine [Internet]. 2018 Dec 31;35(2):187–91. Available from: http://dx.doi.org/10.12701/yujm.2018.35.2.187
Aslamzai M, Froogh BA, Mukhlis AH, Faizi OA, Sajid SA, Hakimi Z. Factors associated with respiratory distress syndrome in preterm neonates admitted to a tertiary hospital in Kabul city: A retrospective cross-sectional study. Global Pediatrics [Internet]. 2023 Mar;3:100035. Available from: http://dx.doi.org/10.1016/j.gpeds.2023.100035.
Karayel Eroglu H, Gulasi S, Mert MK, Cekinmez EK. Relationship between the mode of delivery, morbidity and mortality in preterm infants. Journal of Tropical Pediatrics [Internet]. 2022 Oct 6;68(6): 1-6. Available from: http://dx.doi.org/10.1093/tropej/fmac074.
Alfarwati T, Alamri A, Alshahrani M, Wassia H. Incidence, Risk factors and Outcome of Respiratory Distress Syndrome in Term Infants at Academic Centre, Jeddah, Saudi Arabia. Medical Archives [Internet]. 2019;73(3):183-6. Available from: http://dx.doi.org/10.5455/medarh.2019.73.183-18622.
Abou-Faddan HH, Abdelaziz NHR. Respiratory Distress and Its Outcome among Neonates Admitted to Neonatal Intensive Care Unit of Assiut University Children Hospital, Egypt. The Egyptian Journal of Community Medicine [Internet]. 2018 Apr 1;36(2):69–78. Available from: http://dx.doi.org/10.21608/ejcm.2018.11052.
Wang J, Yan J, Han J, Ning Y, Yan C. Risk factors for respiratory distress syndrome among Chinese infants of 34-42 weeks gestational age: a multi-center observational study. International journal of clinical and experimental medicine [Internet]. 2019;12(4):4354-4360. Available from: www.ijcem.com /ISSN:1940-5901/IJCEM0079039.
Alfirevic Z, Milan SJ, Livio S. Caesarean section versus vaginal delivery for preterm birth in singletons. Cochrane Database of Systematic Reviews [Internet]. 2013 Sep 12;2013(9). Available from: http://dx.doi.org/10.1002/14651858.cd000078.pub3.
Nomura R. Ética na inclusão de gestantes como participantes de pesquisas: Ética e pesquisa em gestantes. Cadernos de Ética em Pesquisa [Internet]. 15º de dezembro de 2019 Dec 15;1(1):9-16. Disponível em: https://cadernosdeeticaempesquisa.emnuvens.com.br/Caderno19/article/view/8.
Thanh BYL, Lumbiganon P, Pattanittum P, Laopaiboon M, Vogel JP, Oladapo OT, et al. Mode of delivery and pregnancy outcomes in preterm birth: a secondary analysis of the WHO Global and Multi-country Surveys. Scientific Reports [Internet]. 2019 Oct 29;9(1). Available from: http://dx.doi.org/10.1038/s41598-019-52015-w.
Lederer DJ, Bell SC, Branson RD, Chalmers JD, Marshall R, Maslove DM, et al. Control of Confounding and Reporting of Results in Causal Inference Studies. Guidance for Authors from Editors of Respiratory, Sleep, and Critical Care Journals. Annals of the American Thoracic Society [Internet]. 2019 Jan;16(1):22–8. Available from: http://dx.doi.org/10.1513/annalsats.201808-564ps.
Ananth CV, Schisterman EF. Confounding, causality, and confusion: the role of intermediate variables in interpreting observational studies in obstetrics. American Journal of Obstetrics and Gynecology [Internet]. 2017 Aug;217(2):167–75. Available from: http://dx.doi.org/10.1016/j.ajog.2017.04.016.
Li Y, Zhang C, Zhang D. Cesarean section and the risk of neonatal respiratory distress syndrome: a meta-analysis. Archives of Gynecology and Obstetrics [Internet]. 2019 Jun 11;300(3):503–17. Available from: http://dx.doi.org/10.1007/s00404-019-05208-7.
Tefera M, Assefa N, Mengistie B, Abrham A, Teji K, Worku T. Elective Cesarean Section on Term Pregnancies Has a High Risk for Neonatal Respiratory Morbidity in Developed Countries: A Systematic Review and Meta-Analysis. Frontiers in Pediatrics [Internet]. 2020 Jun 25;8. Available from: http://dx.doi.org/10.3389/fped.2020.00286.
Ministério da Saúde. Diretrizes Metodológicas - Elaboração de revisão sistemática e metanálise de estudos observacionais comparativos sobre fatores de risco e prognóstico — Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde - CONITEC [Internet]. 2014. Available from: https://www.gov.br/conitec/pt-br/midias/artigos_publicacoes/diretrizes/estudosobservacionais.pdf/view.
Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis. JBI, 2020. Available from https://synthesismanual.jbi.global. https://doi.org/10.46658/JBIMES-20-01.
Barzilay E, Mazaki-Tovi S, Amikam U, de Castro H, Haas J, Mazkereth R, et al. Mode of delivery of twin gestation with very low birthweight: is vaginal delivery safe? American Journal of Obstetrics and Gynecology [Internet]. 2015 Aug;213(2):219.e1-219.e8. Available from: http://dx.doi.org/10.1016/j.ajog.2015.03.030.
Chimenea A, García-Díaz L, Antiñolo G. Mode of delivery, perinatal outcome and neurodevelopment in uncomplicated monochorionic diamniotic twins: a single-center retrospective cohort study. BMC Pregnancy and Childbirth [Internet]. 2022 Feb 1;22(1). Available from: http://dx.doi.org/10.1186/s12884-022-04425-4.
Dencker A, Lyckestam Thelin I, Smith V, Lundgren I, Nilsson C, Li H, et al. Neonatal outcomes associated with mode of subsequent birth after a previous caesarean section in a first pregnancy: a Swedish population-based register study between 1999 and 2015. BMJ Paediatrics Open [Internet]. 2022 Jul;6(1):e001519. Available from: http://dx.doi.org/10.1136/bmjpo-2022-001519.
Indraccolo U, Pace M, Corona G, Bonito M, Indraccolo SR, Di Iorio R. Cesarean section in the absence of labor and risk of respiratory complications in newborns: a case-control study. The Journal of Maternal-Fetal & Neonatal Medicine [Internet]. 2017 Nov 20;32(7):1160–6. Available from: http://dx.doi.org/10.1080/14767058.2017.1401999.
Natile M, Ventura ML, Colombo M, Bernasconi D, Locatelli A, Plevani C, et al. Short-term respiratory outcomes in late preterm infants. Italian Journal of Pediatrics [Internet]. 2014 Jun 3;40(1). Available from: http://dx.doi.org/10.1186/1824-7288-40-52.
Shaikh N, Faizi S, Rai L. Respiratory Morbidity in Late-Preterm Births: A Prospective Observational Study at a Tertiary Care Hospital. The Journal of Obstetrics and Gynecology of India [Internet]. 2016 May 4;66(S1):301–6. Available from: http://dx.doi.org/10.1007/s13224-016-0893-z.
Sun H, Xu F, Xiong H, Kang W, Bai Q, Zhang Y, et al. Characteristics of Respiratory Distress Syndrome in Infants of Different Gestational Ages. Lung [Internet]. 2013 May 31;191(4):425–33. Available from: http://dx.doi.org/10.1007/s00408-013-9475-3.
Tochie JN, Choukem SP, Langmia RN, Barla E, Koki-Ndombo P. Neonatal respiratory distress in a reference neonatology unit in Cameroon: a retrospective analysis of prevalence, predictors, etiologies and outcomes. Pan African Medical Journal [Internet]. 2016;24. Available from: http://dx.doi.org/10.11604/pamj.2016.24.152.7066.
Wondie WT, Legesse BT, Mekonnen GB, Degaga GT, Zemariam AB, Gedefaw GD, et al. Incidence and predictors of respiratory distress syndrome among low birth weight neonates in the first seven days in Northwest Ethiopia Comprehensive Specialized Hospitals, 2023: A retrospective follow-up study. BMJ Open [Internet]. 2023 Nov;13(11):e079063. Available from: http://dx.doi.org/10.1136/bmjopen-2023-079063.
Toijonen A, Heinonen S, Gissler M, Macharey G. Neonatal outcome in vaginal breech labor at 32 + 0—36 + 0 weeks of gestation: a nationwide, population-based record linkage study. BMC Pregnancy and Childbirth [Internet]. 2022 Mar 16;22(1). Available from: http://dx.doi.org/10.1186/s12884-022-04547-9.
Stylianou-Riga P, Boutsikou T, Kouis P, Kinni P, Krokou M, Ioannou A, et al. Maternal and neonatal risk factors for neonatal respiratory distress syndrome in term neonates in Cyprus: a prospective case–control study. Italian Journal of Pediatrics [Internet]. 2021 Jun 3;47(1). Available from: http://dx.doi.org/10.1186/s13052-021-01086-5.
Lehmann S, Baghestan E, Børdahl PE, Irgens LM, Rasmussen S. Perinatal outcome in births after a previous cesarean section at high trial of labor rates. Acta Obstetricia et Gynecologica Scandinavica [Internet]. 2018 Nov 8;98(1):117–26. Available from: http://dx.doi.org/10.1111/aogs.13458.
Ye W, Zhang T, Shu Y, Fang C, Xie L, Peng K, et al. The influence factors of neonatal respiratory distress syndrome in Southern China: a case-control study. The Journal of Maternal-Fetal & Neonatal Medicine [Internet]. 2018 Oct 29;33(10):1678–82. Available from: http://dx.doi.org/10.1080/14767058.2018.1526918.
Hou L, Hellerstein S, Vitonis A, Zou L, Ruan Y, Wang X, et al. Cross sectional study of mode of delivery and maternal and perinatal outcomes in mainland China. Simeoni U, editor. PLOS ONE [Internet]. 2017 Feb 9;12(2):e0171779. Available from: http://dx.doi.org/10.1371/journal.pone.017177946.
Bricelj K, Tul N, Lasic M, Bregar AT, Verdenik I, Lucovnik M, et al. Respiratory morbidity in twins by birth order, gestational age and mode of delivery. Journal of Perinatal Medicine [Internet]. 2016 Apr 18;44(8):899–902. Available from: http://dx.doi.org/10.1515/jpm-2015-0404.
Condò V, Cipriani S, Colnaghi M, Bellù R, Zanini R, Bulfoni C, et al. Neonatal respiratory distress syndrome: are risk factors the same in preterm and term infants? The Journal of Maternal-Fetal & Neonatal Medicine [Internet]. 2016 Aug 2;30(11):1267–72. Available from: http://dx.doi.org/10.1080/14767058.2016.1210597.
Mehrabadi A, Lisonkova S, Joseph KS. Heterogeneity of respiratory distress syndrome: risk factors and morbidity associated with early and late gestation disease. BMC Pregnancy and Childbirth [Internet]. 2016 Sep 27;16(1). Available from: http://dx.doi.org/10.1186/s12884-016-1085-7.
Turitz A, Gyamfi-Bannerman C. Comparison of Respiratory Outcomes between Preterm Small-For-Gestational-Age and Appropriate-For-Gestational-Age Infants. American Journal of Perinatology [Internet]. 2016 Aug 8;34(03):283–8. Available from: http://dx.doi.org/10.1055/s-0036-1586755.
Blue NR, Van Winden K, Pathak B, Barton L, Opper N, Lane CJ, et al. Neonatal Outcomes by Mode of Delivery in Preterm Birth. American Journal of Perinatology [Internet]. 2015 Sep 7;32(14):1292–7. Available from: http://dx.doi.org/10.1055/s-0035-1562931.
Altman M, Vanpée M, Cnattingius S, Norman M. Risk Factors for Acute Respiratory Morbidity in Moderately Preterm Infants. Paediatric and Perinatal Epidemiology [Internet]. 2013 Feb 4;27(2):172–81. Available from: http://dx.doi.org/10.1111/ppe.12035.
Rouse DJ, Hirtz DG, Thom E, Varner MW, Spong CY, Mercer BM, et al. A Randomized, Controlled Trial of Magnesium Sulfate for the Prevention of Cerebral Palsy. New England Journal of Medicine [Internet]. 2008 Aug 28;359(9):895–905. Available from: http://dx.doi.org/10.1056/nejmoa0801187.
Karlström A, Lindgren H, Hildingsson I. Maternal and infant outcome after caesarean section without recorded medical indication: findings from a Swedish case–control study. BJOG: An International Journal of Obstetrics & Gynaecology [Internet]. 2013 Jan 15;120(4):479–86. Available from: http://dx.doi.org/10.1111/1471-0528.12129.
Ghi T, Nanni M, Pierantoni L, Bellussi F, Bacchi Reggiani ML, Faldella G, et al. Neonatal respiratory morbidity in twins versus singletons after elective prelabor caesarean section. European Journal of Obstetrics & Gynecology and Reproductive Biology [Internet]. 2013 Feb;166(2):156–60. Available from: http://dx.doi.org/10.1016/j.ejogrb.2012.10.020.
Liu J, Yang N, Liu Y. High-risk Factors of Respiratory Distress Syndrome in Term Neonates: A Retrospective Case-control Study. Balkan Medical Journal [Internet]. 2014 Mar 10;33(1):64–8. Available from: http://dx.doi.org/10.5152/balkanmedj.2014.8733.
Plunkett BA, Sandoval G, Bailit JL, Reddy UM, Wapner RJ, Varner MW, et al. Association of Labor With Neonatal Respiratory Outcomes at 36–40 Weeks of Gestation. Obstetrics & Gynecology [Internet]. 2019 Sep;134(3):495–501. Available from: http://dx.doi.org/10.1097/aog.0000000000003415.
Kurek Eken M, Şahin Ersoy G, Çetinkaya S, Çam Ç, Karateke A. The effect of labour pain in caesarean delivery on neonatal and maternal outcomes in a term low-risk obstetric population. Journal of Obstetrics and Gynaecology [Internet]. 2017 Jun 20;38(1):27–31. Available from: http://dx.doi.org/10.1080/01443615.2017.1322566.
Emeriaud G, López-Fernández YM, Iyer NP, Bembea MM, Agulnik A, Barbaro RP, et al. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2). Pediatric Critical Care Medicine [Internet]. 2023 Jan 20;24(2):143–68. Available from: http://dx.doi.org/10.1097/pcc.0000000000003147.
Rotta AT, Piva JP, Andreolio C, Carvalho WB de, Garcia PCR. Progress and perspectives in pediatric acute respiratory distress syndrome. Revista Brasileira de Terapia Intensiva [Internet]. 2015;27(3): 266-73. Available from: http://dx.doi.org/10.5935/0103-507x.20150035.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Jessica Wady Lopes, Cinira Assad Simão Haddad, Ana Claudia Tomazetti de Oliveira Novaes (Autor)

This work is licensed under a Creative Commons Attribution 4.0 International License.
Autores que publicam nesta revista concordam com os seguintes termos:
Autores mantém os direitos autorais e concedem à revista o direito de primeira publicação, com o trabalho simultaneamente licenciado sob a Licença Creative Commons Attribution 4.0 que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista.
Autores têm autorização para distribuição não-exclusiva da versão do trabalho publicada nesta revista (ex.: publicar em repositório institucional ou como capítulo de livro), com reconhecimento de autoria e publicação inicial nesta revista.