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Newborns & Risk of Breathing Problems at Birth


Updated July 01, 2014

Newborn baby boy gripping parent's finger
Cultura RM/Charles Gullung/Collection Mix: Subjects/Getty Images
When we talk about medication in pregnancy, most of us think about heavy duty drugs like blood pressure medications, narcotics and anesthesia. We often disregard over-the-counter products as being dangerous. Recently the use of some of these over-the-counter medications, NSAIDs, have come under scrutiny as being particularly dangerous.

NSAIDs are mostly commonly aspirin, ibuprofen and naproxen containing products. Since there are no prescriptions required, we mistakenly believe that there is no harm. In fact, they've become so prevalent in our society, that many of us don't even consider them to be medications. This can also lead to an under-reporting of their use, particularly during pregnancy.

Now it's thought that babies who have been exposed to the NSAIDs have a higher chance of developing persistent pulmonary hypertension of the newborn (PPHN), according to a study in the March issue of Pediatrics, from the American Academy of Pediatrics.

PPHN, also called persistent fetal circulation (PFC), usually shows up within the first 12 hours of life as the newborn is unable to transition from the fetal circulatory ways to that of an adult system as happens in normal, healthy newborns. This can lead to several problems with these infants, including problems breathing and need to have assistance in breathing. There are also other physical conditions that can cause PPHN.

Infants were tested by being placed in two groups: one group who met the criteria for PPHN and a control group of healthy infants. Infants in each group had their meconium tested to detect the presence or absence of the NSAIDs. The first stool was tested using gas chromatography/mass spectrometry for the detection of the NSAIDs. Almost 50% of the PPHN group tested positive for at least one NSAID.

For the infants who suffered from PPHN, the mean time spent on a ventilator for these infants was about 11 days. Nitric oxide treatment (NO) was given to 47% of the positive group. Extra Corporeal Membrane Oxygenation (ECMO) was required for about half of the group treated with NO therapy and two died.

We all want a healthy baby and we do whatever we can to have a healthy baby. This is going to have to include looking at all potential hazards and ensuring that they are reported properly to our health care team. In this study, more than half of the infants who tested positive for these simple over-the-counter products did not have a history that supposedly included these drugs, meaning when the mother was asked if she had taken any medication she denied it, either by simple omission or fear.

In a related article from the American College of Obstetricians and Gynecologists (ACOG), they looked at whether or not the mode of birth (vaginal or cesarean) made it more likely for an infant to suffer from PPHN, respiratory distress or transient tachypnea. They found that PPHN was five times more likely in the cesarean born group. The authors hypothesized that labor must have some beneficial effect on the lungs of the newborn, thus urging physicians to do vigilant monitoring on cesarean born babies and to include this neonatal risk when discussing the informed consent prior to surgery.

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