[Very preterm birth: is maternal anesthesia a risk factor for neonatal intubation in the delivery room?].
OBJECTIVE
To assess the risk of tracheal intubation at birth in very premature neonates related to the type of maternal anesthesia in case of elective cesarean.


METHODS
All 219 live-born very premature neonates (28-32 weeks of gestation), delivered after an elective cesarean in the 27 maternity wards of 2 French semi-rural neonatal networks. Eighty-three percent (182/219) were delivered in level III maternity wards in university hospitals.


RESULTS
Of the very preterm neonates, 33.3% (73/219) were intubated in the delivery room, either for respiratory distress syndrome or a low APGAR score. Very preterm neonates delivered after maternal general anesthesia were more often intubated than those delivered after spinal anesthesia (48.7% vs 25.2%; OR: 2.8; 95% CI: 1.8-5.1). The risk of intubation related to maternal general anesthesia remained statistically significant after an adjustment for gestational age, fetal growth retardation, respiratory distress syndrome, type of maternity ward, and a propensity score that took into account maternal sociodemographic characteristics and the causes of very preterm birth (aOR: 3.4; 95% CI: 1.4-8.2). The risk of intubation related to general anesthesia was lower after adjusting for the 5-min APGAR score (aOR: 2.8; 95% CI: 1.0-7.3).


CONCLUSIONS
Very preterm neonates delivered after cesarean with general anesthesia require tracheal intubation in the delivery room more often than those delivered with spinal anesthesia. This study cannot assess a causal link between anesthesia and the need for neonatal intubation. However, neonatologists have to be aware of the type of maternal anesthesia because it may interfere with the non-invasive ventilation support policy of the very preterm neonate.
CIE1, Inserm, Centre d'Investigation Clinique, d'Epidémiologie Clinique et d'Essais Cliniques, Université de Bourgogne, CHRU de Dijon, 21000 Dijon, France. antoine.burguet@chu-dijon.fr
A
A
Burguet
O
O
Pez
B
B
Debaene
M
M
Untersteller
G
G
Bettinger
S
S
Kayemba-Kays
G
G
Thiriez
M-F
MF
Bouthet
P
P
Sanyas
A
A
Menget
B
B
Mulin
R
R
Maillet
P
P
Boisselier
F
F
Pierre
J-B
JB
Gouyon
D000768:Anesthesia, General / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D001034:Apgar Score; D002585:Cesarean Section / Q000009:adverse effects; D003696:Delivery Rooms; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal; D011247:Pregnancy; D047928:Premature Birth; D012121:Respiration, Artificial / Q000379:methods; D012127:Respiratory Distress Syndrome, Newborn / Q000139:chemically induced / Q000628:therapy*; D012307:Risk Factors