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# Mometrix ## Neonatal Effects of C-Section * Currently, about 30% of deliveries in the United States are by Cesarean section with increasing numbers of women asking for elective C-sections rather than vaginal delivery. * C-sections pose more risk for the neonates because the lungs are not clear...

# Mometrix ## Neonatal Effects of C-Section * Currently, about 30% of deliveries in the United States are by Cesarean section with increasing numbers of women asking for elective C-sections rather than vaginal delivery. * C-sections pose more risk for the neonates because the lungs are not cleared of fluid as they are during labor and vaginal delivery. * If gestational age has not been accurately determined, iatrogenic prematurity may occur with associated respiratory distress. * Even full-term neonates are at increased risk of transient tachypnea of newborn and persistent pulmonary hypertension. * Neonates delivered by C-section typically have low APGAR scores, sometimes related to effects of anesthesia. * The infant can also be cut during the incision. * After delivery, the neonate's respiratory status must be monitored carefully, especially for the first 24 to 48 hours ## Fetal Exposure to AIDS/HIV * Most infants infected with AIDS/HIV acquire the infection from their mothers (vertical transmission). * The perinatal transmission rate is 30% in untreated HIV positive mothers, usually acquired during delivery. * Neonates are usually asymptomatic but are at risk for prematurity, low birth weight, and small for gestational age (SVA). * Infants may show failure to thrive, hepatomegaly, interstitial lymphocytic pneumonia, recurrent infections, and CNS abnormalities. * Optimal treatment reduces the perinatal transmission rate to as low as 1-2%: * Antiviral therapy during the pregnancy * Elective caesarian section before the amniotic membranes rupture * Antiviral medications for the neonate for the first 6 weeks of life. The first dose should be given within the first 6-12 hours after delivery * Avoiding breastfeeding. The risk of HIV transmission with breastfeeding is 0.7% per month of breastfeeding. ## Neonatal HIV Testing * The immunological status of infants with HIV-positive mothers is assessed in a series of tests performed over the first two years in order to institute treatment and decrease transmission to ≥2%: * Birth (224 hours): ELISA and rapid tests are used to identify neonates who test positive at birth. Confirmatory testing is done with the neonate's blood (not cord blood due to possibility of maternal contamination), usually using DNA PCR, which is about 99% sensitive by 1 month, but does NOT detect very recent infection (for instance, infection acquired during the birth). RNA PCR may be used for some subtypes of HIV infection. * In the United States, testing is based on identifying mothers with HIV. If the mother's status is not known, then some states require mandatory testing of the infant. * Laws vary. Based on positive findings, treatment is begun within 24 hours without waiting for confirmatory test results. * Subsequent testing is done at 2, 4, 12, and 18 months.