Perinatal predictors of clinical instability at birth in late-preterm and term infants

To identify characteristics associated with delivery room clinical instability in at-risk infants. Prospective cohort study. Two perinatal centres in Melbourne, Australia. Infants born at >= 35(+0) weeks' gestation with a first-line paediatric doctor requested to attend. Clinical instability defined as any one of heart rate < 100 beats per minute for >= 20 s in the first 10 min after birth, maximum fraction of inspired oxygen of >= 0.70 in the first 10 min after birth, 5-min Apgar score of <7, intubated in the delivery room or admitted to the neonatal unit for respiratory support. Four hundred and seventy-three infants were included. The median (IQR) gestational age at birth was 39(+4) (38(+4)-40(+4)) weeks. Eighty (17%) infants met the criteria for clinical instability. Independent risk factors for clinical instability were labour without oxytocin administration, presence of a medical pregnancy complication, difficult extraction at birth and unplanned caesarean section in labour. Decision tree analysis determined that infants at highest risk were those whose mothers did not receive oxytocin during labour (25% risk). Infants at lowest risk were those whose mothers received oxytocin during labour and did not have a medical pregnancy complication (7% risk). Conclusions: We identified characteristics associated with clinical instability that may be useful in alerting less experienced clinicians to call for senior assistance early. The decision trees provide intuitive visual aids but require prospective validation.

Automated summary

This study aimed to identify characteristics associated with clinical instability in at-risk infants in the delivery room. The findings indicate that factors such as labor without oxytocin administration, medical pregnancy complications, difficult extraction at birth, and unplanned cesarean section in labor are independent risk factors for clinical instability. Decision tree analysis further revealed that infants whose mothers did not receive oxytocin during labor were at the highest risk, while those whose mothers received oxytocin during labor and did not have any medical pregnancy complication were at the lowest risk.