41: Neonatal Resuscitation Following Caesarean Section: A Retrospective Chart Review

Abstract

Infants delivered by elective caesarean section have similar need for resuscitation as infants delivered by spontaneous vaginal deliveries. Approximately 10% of deliveries are estimated to require neonatal resuscitation with 1% requiring extensive measures. A health care provider certified by the Neonatal Resuscitation Program but without advanced airway skills is therefore considered sufficient at low risk deliveries. We undertook this study to determine the use of resuscitation and the health care providers in attendance at caesarean section deliveries in our centre. A retrospective chart review of 200 emergent and elective caesarean section deliveries was conducted in a small urban centre between January 2012 and 2013. Indications for caesarean section delivery were recorded. Health care providers present, whether the infant received suctioning, bag/mask ventilation, oxygen, intubation, or compressions, and APGARS at 1 and 5 minutes were recorded. χ2 tests used to determine potential differences between health care provider type and the use of resuscitation or not. Odds ratios are presented as a measure of effect size. The non-parametric Mann-Whitney test was used to examine differences in Apgar scores by group (resuscitation or not) to account for the significant skew in the distribution of APGAR scores at both 1 and 5 minutes. 220 infants were delivered through 200 caesarean section deliveries. Indications for caesarean section were maternal request (2%), failure to progress (18%), fetal distress (24%), previous caesarian section (35%), fetal indicators (18%), and maternal illness indicators (3%). 108/220 (49%) infants received suctioning, 26/220 (12%) received bag/mask ventilation, 23/220 (10%) received oxygen, and 15/220 (7%) were intubated. No infants required chest compressions. APGARs were lower in the group that received any form of resuscitation (1 minute z=−3.78, P<0.001; 5 minute z=−3.35, P<0.001). Gestational age (P=0.94), multiple fetuses (P=0.86), fetal heart rate (P=0.33), and prolonged rupture of membranes (P=0. 80) were not significantly associated with infants receiving resuscitation. Meconium in liquor (P<0.05) and fetal decelerations (P<0.005) were significantly associated with receiving resuscitation. Infants were less likely to receive resuscitation if a pediatrician was in attendance (P<0.001, OR=0.32, CI=0.16–0.65) however respiratory therapist attendance at the caesarean section significantly increased rate of resuscitation (P<0.01, OR=2.22, CI=1.23–4.02). The resuscitation rate in our centre was found to be significantly higher than expected. It was found that pediatrician presence at delivery decreased resuscitation requirements and respiratory therapist increased risk for resuscitation. Reasons for these observations need to be explored.