Abstract 1182 Poster Session II, Sunday, 5/2 (poster 37)

We evaluated the need for neonatal resuscitation as a marker for Pediatrician attendance at Cesarean deliveries (C/S). An APGAR score of 3 or less @ 1 minute was chosen as an indication of the need for progression from initial stabilization to active resuscitation, ie-need for a Pediatrician. METHOD: Records from all C/S recorded during an 18 month period were evaluated using a regional database (part of a state-wide perinatal database). Delivery data for infants >34 weeks gestational age (GA) who had a 1 minute APGAR score less than 4 were linked to maternal delivery records to assess maternal risk factors, reasons for C/S and outcome of the infant (NICU or non-NICU care). RESULTS: During the 18 month period there were 30,856 deliveries at 23 hospitals with 2684 C/S (1634-primary and 1050-repeat). There were 255 C/S deliveries of infants with GA>34 weeks and APGARS <4 @ 1 minute. The median GA was 39 with a range of 34 to 43 weeks and a median birthweight of 3278 gms with a range of 1500 to 4400. Maternal risk factors associated with the need for for neonatal intervention were (of the 255 cases): 20% with PIH/pre-eclampsia, 10% with a history of multiple fetal losses and 8% with significant anemia. No maternal risk factors were found in 25% of the cases. The need for neonatal resuscitation was also related to the reason for the C/S; of the 255, 60% were done for "fetus at risk" and 28% for fetal malpresentation. The indications were similar for both primary and repeat C/S. The number of infants who required NICU care was 30% (76/255) and the ratio of repeat/primary C/S was similar for infants regardless of the need for eventual NICU care. The distribution of APGAR scores (<4) was similar for infants who required NICU and non-NICU care (approximately 33% for each APGAR 1-3). CONCLUSION: The majority of C/S that result in a neonate requiring stabilization and resuscitation are related to a small number of maternal risk factors and the reason for the C/S. The fact that approximately 10% of the infants needing resuscitation had no identifiable antecedent maternal risk or fetal risk factor underscores the need for the presence of an individual at each delivery who is capable of initiating a neonatal resuscitation.