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Infants born through cesarean section are more likely to require hospitalization for bronchiolitis compared with infants born through spontaneous vaginal delivery, according to research presented at the Pediatric Academic Societies Meeting. Researchers said the season in which the infant is born may also affect the risk for hospitalization.

According to Lindsey C. Douglas, MD, assistant professor of pediatrics at Mount Sinai Kravis Children’s Hospital, and colleagues, one suggested cause of bronchiolitis in infants is impaired immunity, and birth through cesarean section can impair infant immunity by limiting exposure to the maternal vaginal microbiome.

“There are few known modifiable risk factors for severe bronchiolitis requiring hospitalization in infancy,” Douglas told Infectious Diseases in Children. “We know that immunity plays a role in how infants respond to viral illness. We found that infants who are born by cesarean section have higher odds of being hospitalized for bronchiolitis in the subsequent 2 years compared with vaginal birth. Many of these C-sections were elective.”

Douglas and colleagues led a retrospective cohort study of 124,526 Israeli infants born between 2008 and 2010. They examined demographic and clinical characteristics at birth as well as bronchiolitis hospitalization up to age 2 years.

Of the infants included in the study, 4.1% (n = 5,102) were hospitalized for bronchiolitis. Infants who were born through cesarean section were more likely to be hospitalized compared with infants born through spontaneous vaginal delivery, but the risk varied depending on the season (OR for winter = 1.26 [97.5% CI, 1.10-1.44]; OR for spring = 1.38 [97.5% CI, 1.15-1.65]; OR for summer = 1.36 [97.5% CI, 1.28-1.57]; and OR for fall = 1.14 [97.5% CI, 1.01-1.28]).

The results are supported by another study, which found that infants born through caesarean section have an altered gut microbiota that may leave them more susceptible to respiratory infections in the first year of life.

“We are careful not to make recommendations about cesarean sections since we are pediatricians,” Douglas said. “We found that cesarean section is associated with increased odds of hospitalization, especially for infants born in spring and summer. We suggest more prospective research needs to be done. However, this study should be considered when the C-section is elective and vaginal delivery is a safe option for the mother and infant.” – by Katherine Bortz

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