Catecholamine Surge and Metabolic Adaptation in the Newborn after Vaginal Delivery and Caesarean Section

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Abstract
The immediate postnatal metabolic adaptation and sympatho-adrenal activation were studied in infants delivered vaginally or by elective cesarean section. Vaginally delivered infants showed high catecholamine levels at birth compared to infants born by cesarean section under epidural or general anesthesia. Umbilical arterial glucose levels were significantly higher in the vaginal group than in both cesarean section groups. At 30 min, all groups showed a marked decrease with several infants showing asymptomatic hypoglycemia in the cesarean section group. C-peptide levels showed no difference at birth but later became significantly higher in the vaginal group. Although the levels of free fatty acids and glycerol were low at birth, they were significantly higher in the vaginal group. In all groups they increased substantially with time. Considering the marked differences in catecholamine levels, the differences in metabolic adaptation were unexpectedly small. This implies an attenuated metabolic response to sympatho-adrenal stimulation in the newborn.