Predictors of respiratory depression at birth in the term infant

BJOG. 2006 Jul;113(7):769-74. doi: 10.1111/j.1471-0528.2006.00987.x.


Objective: To evaluate predictive factors for respiratory depression at birth in infants >/=37 weeks.

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

Setting: Nova Scotia, Canada.

Population: 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.

Main outcome measures: 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.

Conclusion: 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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asphyxia Neonatorum / epidemiology
  • Cohort Studies
  • Early Diagnosis
  • Female
  • Humans
  • Hypoxia-Ischemia, Brain / epidemiology
  • Infant, Newborn
  • Maternal Age
  • Nova Scotia / epidemiology
  • Pregnancy
  • Pregnancy Complications / epidemiology
  • Prenatal Diagnosis / standards
  • Prognosis
  • Respiratory Insufficiency / epidemiology
  • Respiratory Insufficiency / prevention & control*
  • Risk Assessment
  • Risk Factors
  • Seizures / epidemiology