Elective cesarean delivery, neonatal intensive care unit admission, and neonatal respiratory distress

To evaluate the relationship among gestational age at elective cesarean delivery, neonatal intensive care unit (NICU) admission, and whether the presence of pre-cesarean delivery labor or ruptured membranes affected the incidence of neonatal respiratory distress.

A chart review was performed of all elective caesarean deliveries (documented planned in advance) during 1 year, 2004-2005, in the Calgary Health Region; resulting in liveborn infants at or after 36 weeks of gestation and birth weight equal to or greater than 2,500 g. The primary outcomes are relative risk of NICU admission or respiratory distress.

A total of 1,193 paired maternal and infant charts were reviewed. Admission rate to the NICU was 156 of 1,195 (13.1%). The most common admitting diagnosis was respiratory distress, 126 of 156 (80%). Male gender was a significant risk factor for admission to the NICU or respiratory distress (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.27-2.60, and OR 1.98, 95% CI 1.33-2.95, respectively). Elective cesarean delivery beyond 270 days of gestational age (38(4/7) weeks) significantly reduced the risk for NICU admission or respiratory distress (OR 0.62, 95% CI 0.43-0.89, and OR 0.50, 95% CI 0.34-0.74, respectively). The presence of spontaneous contractions or rupture of membranes before elective cesarean delivery did not reduce the risk of NICU admission or respiratory distress (OR 1.05, 95% CI 0.69-1.62, and OR 0.96, 95% CI 0.60-1.55, respectively).

Admission to NICU and development of respiratory distress were associated with gestational age at time of elective cesarean delivery and male gender. Awaiting the onset of labor or ruptured membranes did not appear to reduce the risk of NICU admission or neonatal respiratory distress.