Currently, the standard of care for newborns is to have all deliveries attended by at least one practitioner trained in advanced neonatal resuscitation, which includes being able to perform positive pressure ventilation and chest compressions. However, if extensive resuscitation is anticipated it is expected that at least one practitioner who can perform a complete resuscitation, which includes endotracheal intubation, be present. These guidelines do not specify the level of training required to attend these deliveries, but it is generally practiced that all “high risk” deliveries, which include preterm deliveries (gestational age less than 37 weeks), assisted deliveries (vacuum, forceps), all cesarean sections (CS), meconium stained amniotic fluid, multiple gestation and presence of fetal distress be attended by a pediatric medical staff. With the increasing incidence of CS, the debate remains whether the presence of a pediatric medical staff is necessary and cost effective for singleton, term, deliveries born via CS.
The incidence of CS in the United States rose to 31.1% of pregnancies in 2006 from 20.7% in 1996. With more mothers opting for elective CS, the increasing costs of medical care, and obstetricians practicing defensive medicine, the neonatal risks involved with CS and the required attendance of a high risk team at these deliveries need to be evaluated.
We aim to determine the incidence and type of resuscitation required for infants delivered at > 37 weeks gestation born by normal spontaneous vaginal delivery (NSVD) versus routine CS.
Retrospective chart review of all singleton births > 37 weeks gestation was analyzed over a 3 year period to determine the number and type of resuscitation, and number of low 1 minute APGAR scores for each mode of delivery.
1540 singleton deliveries born at > 37 weeks gestation were reviewed. Of these, 530 were NSVD, without a high risk delivery team present and 344 were routine CS under regional anesthesia. The need for bag and mask ventilation was 2.1% in the NSVD group and 5.8% in the CS group (RR= 2.8 95%, CI = 1.4-5.7) . The need for intubation was 0.75% in the NSVD group and 3.2% in the CS group (RR = 4.23, 95% CI = 1.36-13.2). The incidence of low 1 minute APGAR defined as <7 was 6.2% in NSVD and 18% in CS with a (RR = 2.95, 95% CI = 1.97-4.38).
When CS are performed under elective circumstances or in the absence of fetal distress, the risk to the infant is low. Although there is a slight increase in resuscitation in infants born via CS, it is not clinically significant, and does not necessitate the routine attendance of a pediatrician and/or nurse practitioner.