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Effect of enhanced recovery after surgery for elective cesarean deliveries on neonatal outcomes



To evaluate the impact of initiation of an enhanced recovery after cesarean delivery (ERAC) protocol for elective cesarean delivery (CD) on neonatal outcomes.

Study design

We performed a retrospective analysis of elective CD at ≥39 weeks gestational age between September 2014 and August 2018 at a single institution before and after ERAC protocol implementation. Our primary outcome was composite neonatal complication rate and secondary outcome was rate of breastfeeding. We performed univariate analyses to detect differences in outcomes between the pre-ERAC and post-ERAC groups.


We included 362 neonates born via elective CD before (n = 135) and after (n = 227) ERAC implementation. The post-ERAC group experienced fewer composite neonatal complications (33.0% vs. 47.4%, p = 0.009) and greater breastfeeding rates (80.2% vs. 67.4%, p = 0.009) compared to the pre-ERAC group.


ERAC protocol implementation does not negatively impact neonates and may benefit both mother and baby.

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The authors would like to thank the Division of Perioperative Informatics (Department of Anesthesiology, University of Virginia, Charlottesville, VA) for their support and assistance with data collection.

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Authors and Affiliations



SSC and JSS conceptualized, designed, drafted, reviewed, and revised the paper. KKR collected data, drafted, reviewed, and revised the paper. KTF drafted, reviewed, and revised the paper. ZOK carried out the initial analyses, and reviewed and revised the paper. ALK reviewed and revised the paper. MT conceptualized and designed the study, reviewed, and revised the paper. SNS carried out the initial analyses, and reviewed and revised the paper. All authors approved the final paper as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Sunny S. Chiao.

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The authors declare no competing interests.

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Chiao, S.S., Razzaq, K.K., Sheeran, J.S. et al. Effect of enhanced recovery after surgery for elective cesarean deliveries on neonatal outcomes. J Perinatol 42, 1283–1287 (2022).

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