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Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 1999 Mar;80(2):F88–F92. doi: 10.1136/fn.80.2.f88

Randomised controlled trial of effect of terbutaline before elective caesarean section on postnatal respiration and glucose homeostasis

G Eisler, R Hjertberg, H Lagercrantz
PMCID: PMC1720915  PMID: 10325782

Abstract

AIM—To determine if terbutaline given to mothers before elective caesarean section facilitates neonatal respiration and metabolism.
METHODS—A randomised controlled trial of 25 full term infants delivered by elective caesarean section was conducted. The mothers received a continuous infusion of terbutaline or saline 120-0 minutes before birth. Umbilical artery blood was collected at birth and analysed for blood gases and catecholamines. The lung function of each infant was assessed two hours after birth, and blood pressure, heart rate, blood glucose and body temperature were monitored until 24 hours of age.
RESULTS—The infants of the treated mothers (n=13) had significantly higher dynamic lung compliance (p<0.001), lower airway resistance (p<0.001), and respiratory frequency than control infants (n=12). Blood glucose and adrenaline concentrations were significantly higher in the treated group (p=0.0014 and p<0.01). None of these infants had any clinical respiratory difficulties; there were two cases of transient tachypnoea in the control group. No negative side effects due to the terbutaline treatment were seen among the infants. The mothers felt no discomfort caused by the terbutaline infusion, although they bled more during surgery (p=0.03).
CONCLUSION—Stimulation of the β adrenoceptors in utero with terbutaline infusion to the mothers promotes neonatal respiratory and metabolic adaptation after elective caesarean section.



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Selected References

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  1. Bergman B., Hedner T. Antepartum administration of terbutaline and the incidence of hyaline membrane disease in preterm infants. Acta Obstet Gynecol Scand. 1978;57(3):217–221. doi: 10.3109/00016347809154885. [DOI] [PubMed] [Google Scholar]
  2. Bergman B., Hedner T., Lundborg P. Pressure-volume relationship and fluid content in fetal rabbit lung after beta-receptor-stimulating drugs. Pediatr Res. 1980 Sep;14(9):1067–1070. doi: 10.1203/00006450-198009000-00009. [DOI] [PubMed] [Google Scholar]
  3. Bistoletti P., Nylund L., Lagercrantz H., Hjemdahl P., Ström H. Fetal scalp catecholamines during labor. Am J Obstet Gynecol. 1983 Dec 1;147(7):785–788. doi: 10.1016/0002-9378(83)90038-8. [DOI] [PubMed] [Google Scholar]
  4. Boog G., Brahim M. B., Gandar R. Beta-mimetic drugs and possible prevention of respiratory distress syndrome. Br J Obstet Gynaecol. 1975 Apr;82(4):285–288. doi: 10.1111/j.1471-0528.1975.tb00635.x. [DOI] [PubMed] [Google Scholar]
  5. Boutroy M. J. Fetal and neonatal effects of the beta-adrenoceptor blocking agents. Dev Pharmacol Ther. 1987;10(3):224–231. doi: 10.1159/000457747. [DOI] [PubMed] [Google Scholar]
  6. Brown M. J., Olver R. E., Ramsden C. A., Strang L. B., Walters D. V. Effects of adrenaline and of spontaneous labour on the secretion and absorption of lung liquid in the fetal lamb. J Physiol. 1983 Nov;344:137–152. doi: 10.1113/jphysiol.1983.sp014929. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Christensson K., Siles C., Cabrera T., Belaustequi A., de la Fuente P., Lagercrantz H., Puyol P., Winberg J. Lower body temperatures in infants delivered by caesarean section than in vaginally delivered infants. Acta Paediatr. 1993 Feb;82(2):128–131. doi: 10.1111/j.1651-2227.1993.tb12622.x. [DOI] [PubMed] [Google Scholar]
  8. Cole M. D., Peevy K. Hypoglycemia in normal neonates appropriate for gestational age. J Perinatol. 1994 Mar-Apr;14(2):118–120. [PubMed] [Google Scholar]
  9. Cottrill C. M., McAllister R. G., Jr, Gettes L., Noonan J. A. Propranolol therapy during pregnancy, labor, and delivery: evidence for transplacental drug transfer and impaired neonatal drug disposition. J Pediatr. 1977 Nov;91(5):812–814. doi: 10.1016/s0022-3476(77)81049-4. [DOI] [PubMed] [Google Scholar]
  10. Faxelius G., Hägnevik K., Lagercrantz H., Lundell B., Irestedt L. Catecholamine surge and lung function after delivery. Arch Dis Child. 1983 Apr;58(4):262–266. doi: 10.1136/adc.58.4.262. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Faxelius G., Lagercrantz H., Yao A. Sympathoadrenal activity and peripheral blood flow after birth: comparison in infants delivered vaginally and by cesarean section. J Pediatr. 1984 Jul;105(1):144–148. doi: 10.1016/s0022-3476(84)80381-9. [DOI] [PubMed] [Google Scholar]
  12. Gladstone G. R., Hordof A., Gersony W. M. Propranolol administration during pregnancy: effects on the fetus. J Pediatr. 1975 Jun;86(6):962–964. doi: 10.1016/s0022-3476(75)80236-8. [DOI] [PubMed] [Google Scholar]
  13. Gowen C. W., Jr, Lawson E. E., Gingras J., Boucher R. C., Gatzy J. T., Knowles M. R. 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 Jul;113(1 Pt 1):121–127. doi: 10.1016/s0022-3476(88)80545-6. [DOI] [PubMed] [Google Scholar]
  14. Greenough A., Lagercrantz H. Catecholamine abnormalities in transient tachypnoea of the premature newborn. J Perinat Med. 1992;20(3):223–226. doi: 10.1515/jpme.1992.20.3.223. [DOI] [PubMed] [Google Scholar]
  15. Hägnevik K., Faxelius G., Irestedt L., Lagercrantz H., Lundell B., Persson B. Catecholamine surge and metabolic adaptation in the newborn after vaginal delivery and caesarean section. Acta Paediatr Scand. 1984 Sep;73(5):602–609. doi: 10.1111/j.1651-2227.1984.tb09982.x. [DOI] [PubMed] [Google Scholar]
  16. Hägnevik K., Lagercrantz H., Sjöqvist B. A. Establishment of functional residual capacity in infants delivered vaginally and by elective cesarean section. Early Hum Dev. 1991 Nov;27(1-2):103–110. doi: 10.1016/0378-3782(91)90031-w. [DOI] [PubMed] [Google Scholar]
  17. 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. doi: 10.3109/00016348409157136. [DOI] [PubMed] [Google Scholar]
  18. Irestedt L., Lagercrantz H., Hjemdahl P., Hägnevik K., Belfrage P. Fetal and maternal plasma catecholamine levels at elective cesarean section under general or epidural anesthesia versus vaginal delivery. Am J Obstet Gynecol. 1982 Apr 15;142(8):1004–1010. doi: 10.1016/0002-9378(82)90783-9. [DOI] [PubMed] [Google Scholar]
  19. Jones C. M., 3rd, Greiss F. C., Jr The effect of labor on maternal and fetal circulating catecholamines. Am J Obstet Gynecol. 1982 Sep 15;144(2):149–153. doi: 10.1016/0002-9378(82)90616-0. [DOI] [PubMed] [Google Scholar]
  20. Lagercrantz H., Bistoletti P. Catecholamine release in the newborn infant at birth. Pediatr Res. 1977 Aug;11(8):889–893. doi: 10.1203/00006450-197708000-00007. [DOI] [PubMed] [Google Scholar]
  21. Lawson E. E., Brown E. R., Torday J. S., Madansky D. L., Taeusch H. W., Jr The effect of epinephrine on tracheal fluid flow and surfactant efflux in fetal sheep. Am Rev Respir Dis. 1978 Dec;118(6):1023–1026. doi: 10.1164/arrd.1978.118.6.1023. [DOI] [PubMed] [Google Scholar]
  22. McBride J. T., McBride M. C., Viles P. H. Hypoglycemia associated with propranolol. Pediatrics. 1973 Jun;51(6):1085–1087. [PubMed] [Google Scholar]
  23. Milner A. D., Saunders R. A., Hopkin I. E. Effects of delivery by caesarean section on lung mechanics and lung volume in the human neonate. Arch Dis Child. 1978 Jul;53(7):545–548. doi: 10.1136/adc.53.7.545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Morrison J. J., Rennie J. M., Milton P. J. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynaecol. 1995 Feb;102(2):101–106. doi: 10.1111/j.1471-0528.1995.tb09060.x. [DOI] [PubMed] [Google Scholar]
  25. Padbury J. F., Roberman B., Oddie T. H., Hobel C. J., Fisher D. A. Fetal catecholamine release in response to labor and delivery. Obstet Gynecol. 1982 Nov;60(5):607–611. [PubMed] [Google Scholar]
  26. Patel D. M., Donovan E. F., Keenan W. J. Transient respiratory difficulty following cesarian delivery. Biol Neonate. 1983;43(3-4):146–151. doi: 10.1159/000241621. [DOI] [PubMed] [Google Scholar]
  27. Reed R. L., Cheney C. B., Fearon R. E., Hook R., Hehre F. W. Propranolol therapy throughout pregnancy: a case report. Anesth Analg. 1974 Mar-Apr;53(2):214–214. [PubMed] [Google Scholar]
  28. Robert M. F., Neff R. K., Hubbell J. P., Taeusch H. W., Avery M. E. Association between maternal diabetes and the respiratory-distress syndrome in the newborn. N Engl J Med. 1976 Feb 12;294(7):357–360. doi: 10.1056/NEJM197602122940702. [DOI] [PubMed] [Google Scholar]
  29. Srinivasan G., Pildes R. S., Cattamanchi G., Voora S., Lilien L. D. Plasma glucose values in normal neonates: a new look. J Pediatr. 1986 Jul;109(1):114–117. doi: 10.1016/s0022-3476(86)80588-1. [DOI] [PubMed] [Google Scholar]
  30. Usher R. H., Allen A. C., McLean F. H. Risk of respiratory distress syndrome related to gestational age, route of delivery, and maternal diabetes. Am J Obstet Gynecol. 1971 Nov;111(6):826–832. doi: 10.1016/0002-9378(71)90495-9. [DOI] [PubMed] [Google Scholar]
  31. Walters D. V., Olver R. E. The role of catecholamines in lung liquid absorption at birth. Pediatr Res. 1978 Mar;12(3):239–242. doi: 10.1203/00006450-197803000-00017. [DOI] [PubMed] [Google Scholar]

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