Non-invasive evaluation of the adaptations of cardiac function in the neonatal period: a comparison of healthy infants delivered by vaginal route and caesarean section.

Postnatal adaptations of cardiac hemodynamics in infants born vaginally or by caesarean section may be different. These cardiac functions were evaluated by Doppler echocardiography to assess adaptation differences. Cardiac output, heart rate, stroke volume, mean arterial pressure, total systemic vascular resistance, ejection fraction, and ductus arteriosus diameter were determined and compared at 1, 24 and 72 h of life in 22 infants born vaginally (group 1) and 23 born by caesarean section (group 2). One hour after delivery, heart rate, mean blood pressure, and total systemic resistance were found to be higher in group 1 infants (P < 0.01, P < 0.05, P < 0.05 respectively). Stroke-volume measurements were significantly higher in group 2 (P < 0.05). The ejection fraction and cardiac output values were similar in both groups. At 24 and 72 h, no significant differences were observed in measurements of infants born vaginally or by caesarean section. We did not find a parameter negatively affecting healthy newborns in either mode of delivery. However, under pathological conditions affecting the cardiovascular system at 1 h of life, including perinatal infections and hypoxemia, a lower stroke volume, higher heart rate, higher mean blood pressure, and higher peripheral resistance may cause additional work load to the cardiovascular system in infants born vaginally.

Analysis of meatal location in 300 boys.

The high incidence of anterior hypospadias and the consideration of some of the parents that this location is a normal variation and the resistance to the surgical treatment led us to investigate the normal meatal location in boys. The location of external meatus was analyzed in 300 boys. The meatal location was classified as type A (anterior third/tip of the glans) type B (middle third) and type C (posterior third/glandular hypospadias). Of the 300 boys taken into study, in 282 (94%) meatus was located at the tip of the glans in 14 patients (4.6%) on the middle third, 'type B' and in 2 patients (0.6%) on the posterior third, 'type C'. The present study clearly demonstrated that the true location of urethral meatus should be at the tip of the glans. Type B is an acceptable location, which requires no operation and is seen in a very small percentage. Type C is a true glandular hypospadias and should certainly be corrected by glanuloplasty and meatal advancement. We are of the opinion that after surgery for anterior hypospadias meatal position presenting elsewhere than at the tip of the glans should not be considered a successful intervention.