What are the Risk Factors Associated with the Need for Neonatal Resuscitation

These are the risk factors for the possible need for neonatal resuscitation.* Every birth should be attended by at least one person skilled in all aspects of neonatal resuscitation. However, if any of the antepartum or intrapartum risk factors in the tables below, it is a very good idea to have one or more persons skilled in neonatal resuscitation present (if possible).

But “Always be prepared to resuscitate. Although identifying risk factors will be helpful to identify some at-risk babies, there still will be some newborns with no risk factors who will need resuscitation.”*

Antepartum Factors

Maternal diabetes Preterm gestation
Gestational hypertension or preeclampsia Multiple gestation
Chronic hypertension Size-dates discrepancy
Fetal anemia or isoimmunization Drug therapy, such as magnesium
Previous fetal or neonatal death Adrenergic agonists
Bleeding in second or third trimester Maternal substance abuse
Maternal infection Fetal malformation or anomalies
Maternal cardiac, renal, pulmonary, thyroid, or neurologic disease Diminished fetal activity
Polyhydramnios No prenatal care
Oligohydramnios Mother older than 35 years
Premature rupture of membranes  
Fetal hydrops  

Intrapartum Factors

Emergency cesarean section Category 2 or 3 fetal heart rate patterns
Forceps or vacuum-assisted delivery Use of general anesthesia
Breech or other abnormal presentation Uterine tachysystoly with fetal heart rate changes
Premature labor Narcotics administered to mother within 4 hours of delivery
Precipitous labor Meconium-stained amniotic fluid
Chorioamnionitis Prolapsed cord
Prolonged rupture of membranes (>18 hours before delivery) Abruptio placentae
Prolonged labor (>24 hours) Placenta previa
Macrosomia Significant intrapartum bleeding


*Neonatal Resuscitation Textbook, 6th ed, 2011, American Academy of Pediatrics, p.16.

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