FACTORS ASSOCIATED WITH A NEED FOR RESUSCITATION IN TERM DELIVERIES

• Published in: Pediatrics (Evanston) Vol. 104; no. 3; p. 745
• Main Authors: Aouthmany, Moustafa M, Edwards, Dale, Fenn-Buderer, Nancy M
• Format: Journal Article
• Language: English
• Published: American Academy of Pediatrics 01-09-1999
• Subjects: Pediatrics
• ISSN: 0031-4005; 1098-4275

Background: Numerous factors alert the perinatal team to the possibility of a newborn who will need resuscitation and it will be advantageous to be able to identify and prioritize these factors. Objective: To identify prenatal factors which may alert the resuscitation team to a depressed term newborn on delivery. A depressed infant is defined for this study as one who had a 1-minute Apgar [is less than or equal to] 5, or received resuscitation with intubation and/or bag and mask ventilation. Methods: Charts from 1117 consecutive term births in 1994 at an urban community teaching hospital were reviewed. Inclusion criteria were term ([is greater than or equal to] 38-[is less than or equal to] 42 weeks gestational age) vaginal or cesarean section deliveries, excluding deliveries under general anesthesia or multiple anomalies. Results: In 1117 term deliveries, 49 had a 1-minute Apgar score [is less than or equal to] 5 and 77 received resuscitation. Combined, 96 infants (8.6%) were depressed. Factors significantly associated (p [is less than or equal to] 0.05) with depressed infants included cesarean section delivery, meconium staining, and breech delivery. Weak associations (0.05 [is less than] p [is less than or equal to] 0.10) were found with maternal fever, no prenatal care, vaginal bleeding, deceleration. There was no association (p [is greater than] 0.10) with gender, artificial rupture of membranes, GBS, foul smelling amniotic fluids, failure to progress, macrosomia/LGA, use of cigarettes or drugs. Conclusion: C-Section and breech deliveries and meconium staining are factors which increase the potential for a low 1-minute Apgar score and/or need for resuscitation. Predicting a need for resuscitation with certainty is impossible; a person(s) competent in neonatal resuscitation must be present at all deliveries.