(519) Risk factors associated with unexpected neonatal resuscitation among term neonates in uncomplicated pregnancies

Unexpected neonatal resuscitation (NR) in anticipated smooth deliveries is troubling without available neonatologists. This study evaluated risk factors for unexpected NR in singleton pregnancies with planned cesarean deliveries after 36 weeks gestation and no fetal abnormalities.

Study Design:

This retrospective cohort study included singleton pregnant women at our hospital who received prenatal care from the first trimester, had no fetal abnormalities, and delivered via planned cesarean section after 36 weeks of gestation, between 2013 and 2023. Only cases with stable vital signs and no significant blood loss from anesthesia to delivery were included. Women with medical conditions requiring hospitalization were excluded. Cases were divided into the NR group (5-minute Apgar score < 7) and the control group. Maternal characteristics, medical history, and laboratory tests from the first trimester and the last visit before delivery were reviewed. We formulated a scoring model after performing multivariable analysis using adjusted odds ratios (aOR).

Results:

A total of 5,324 cases were included, with the NR group comprising 78 cases (1.5%). Five variables were associated with unexpected NR: prior preterm birth (aOR 5.6, 95%CI 1.9-16.2, P=0.002), psychiatric medication during pregnancy (aOR 10.3, 95%CI 1.8-59.2, P=0.009), leukocytosis (WBC count ≥15,000/mm³) in the first trimester (aOR 4.1, 95%CI 1.5-11.2, P=0.007), leukocytosis just before delivery (aOR 3.1, 95%CI 1.3-7.5, P=0.010), and increased HbA1c (≥6.0%) just before delivery (aOR 2.7, 95%CI 1.1-7.0, P=0.048). We formulated a scoring model, assigning each factor a score of 1 to 4 based on the aOR. A score of 4 out of 13 had a sensitivity of 72% and a specificity of 82% for predicting unexpected NR. The AUC was 0.817 (P< 0.001).

Conclusion:

Prior PTB, psychiatric medication, leukocytosis in the first trimester, leukocytosis just before delivery, and increased HbA1c just before delivery were identified as risk factors for unexpected NR in uncomplicated pregnancies. This scoring model may provide useful information for predicting unexpected NR.