Neonatal Outcomes with Regional versus General Anesthesia for Cesarean Delivery: A Meta-analysis of Randomized...

Neonatal outcomes with regional anesthesia (spinal, epidural, or combined spinal-epidural) versus general anesthesia for cesarean delivery remain poorly characterized. The authors performed a meta-analysis of randomized trials to compare neonatal outcomes associated with each technique. They hypothesized that regional anesthesia would be associated with higher Apgar scores and less need for respiratory support and neonatal intensive care after delivery.

The authors searched randomized controlled trials comparing regional versus general anesthesia for patients undergoing cesarean delivery between January 1994 and November 2023. They abstracted information on study characteristics, Apgar score at 1 and 5 min, need for respiratory support after delivery, and need for neonatal intensive care. They analyzed summary data using random effects models and assessed risk of bias using the Cochrane Risk of Bias 2 scale.

A total of 36 studies involving 3,456 neonates were included. Of the neonates, 42.7% (n = 1,476) were born to parturients who underwent general anesthesia, and 57.3% (n = 1,980) were born to parturients who underwent regional anesthesia. Apgar scores at 1 and 5 min were slightly higher after regional versus general anesthesia (mean difference at 1 min, 0.58 points; 95% CI, 0.36 to 0.79; P < 0.001; mean difference at 5 min, 0.09 points; 95% CI, 0.05 to 0.13; P < 0.001). Respiratory support was less often required with regional anesthesia (risk ratio, 0.62; 95% CI, 0.40 to 0.94; P = 0.03). Need for neonatal intensive care did not differ across techniques (risk ratio, 0.75; 95% CI, 0.46 to 1.21; P = 0.24). All studies had high or unclear risk of bias.

Regional anesthesia for cesarean delivery is associated with slightly higher Apgar scores and less frequent need for neonatal respiratory support than general anesthesia. Additional studies are required to determine associations of anesthesia technique with need for intensive care and longer-term outcomes.