Predictors of respiratory depression at birth in the term infant.
OBJECTIVE
To evaluate predictive factors for respiratory depression at birth in infants >/=37 weeks.


METHODS
A population-based cohort study of respiratory depression at birth at term and post-term.


METHODS
Nova Scotia, Canada.


METHODS
All 126 604 nonanomalous, singleton deliveries >/=37 weeks in cephalic presentation from 1988-2002.


METHODS
An analysis of maternal, antenatal, intrapartum, and neonatal factors associated with respiratory depression at birth >/=37 weeks.


METHODS
A composite outcome of delay in initiating and maintaining respiration after birth, 5-minute Apgar score </= 3, or neonatal seizures due to hypoxic-ischaemic encephalopathy.


RESULTS
The rate of respiratory depression at birth with delay in respiration was 5.2/1000, with Apgar </= 3 1.0/1000 live births, and with neonatal seizures 0.7/1000. A composite of any of the three respiratory depressions at birth criteria showed comparable low rates with spontaneous delivery (4.4/1000) and elective caesarean (4.8/1000). Compared with elective caesarean delivery, vacuum (13.2/1000, relative risk [RR] 3.97, P < 0.001), forceps (8.8/1000, RR 1.84, P= 0.003), failed vacuum (13.3/1000, RR 2.76, P= 0.005), failed forceps (33.3/1000, RR 6.93, P < 0.001), and caesarean in labour (17.0/1000, RR 3.54, P < 0.001) had significantly higher rates of the composite outcome.


CONCLUSIONS
Overall, the rate of respiratory depression at birth in the term infant was low and the serious manifestation of seizures was less than 1 in 1000. There was a significant relationship between operative delivery in labour and respiratory depression at birth.
Baskett
T F
TF
Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada. tnaskett@ns.sympatico.ca
Allen
V M
VM
O'Connell
C M
CM
Allen
A C
AC
D001238:Asphyxia Neonatorum / Q000453:epidemiology; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000453:epidemiology; D007231:Infant, Newborn; D008423:Maternal Age; D009674:Nova Scotia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011296:Prenatal Diagnosis / Q000592:standards; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology