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.
