Early indicators of NICU admission for ongoing respiratory support in caesarean-delivered late preterm and term neonates requiring non-invasive respiratory support within the first 15 min after birth: a post hoc analysis - Summary - MDSpire
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Early predictors of NICU admission for continued respiratory support in late preterm and term neonates born by caesarean delivery who receive non-invasive support within 15 minutes of birth: a post hoc analysis
To assess whether clinical parameters recorded during the first 15 minutes after birth are associated with NICU admission for respiratory support continuing beyond 60 minutes.
Approach:
Design and setting: Post hoc analysis of prospectively collected data from three observational studies conducted at a single tertiary NICU in Graz, Austria, between 2018 and 2024.
Participants: 105 neonates born by caesarean delivery at ≥34 weeks’ gestation who received non-invasive respiratory support within 15 minutes of birth.
Outcome: NICU admission for continued respiratory support beyond 60 minutes after birth.
Key Findings:
Thirty neonates were admitted to the NICU; 75 stabilised in the delivery room.
Compared with the non-NICU group, the NICU group had lower gestational age, birth weight, 10-minute Apgar scores, oxygen saturation and SpO₂/FiO₂ ratio, and higher heart rates at 15 minutes; it also included more males.
In multivariable regression, lower gestational age (p=0.010) and lower SpO₂/FiO₂ ratio at 15 minutes (p<0.001) were independently associated with NICU admission.
Interpretation:
In this selected cohort, gestational age and the SpO₂/FiO₂ ratio measured during the first 15 minutes were independently associated with subsequent NICU admission for ongoing respiratory support.
Limitations:
This was an exploratory post hoc analysis of a small cohort from a single tertiary centre.
The outcome reflects both neonatal respiratory status and local clinical workflow.
The authors state that larger prospective studies are needed to validate the candidate indicators.
Conclusion:
The authors call for larger prospective studies to validate early clinical indicators and assess their role in decision-making; they also identify adjunctive non-invasive methods, including lung ultrasound, as a topic for future research.
by Melina Winkler, Nariae Baik-Schneditz, Viktoria Gruber, Christoph Schlatzer, Daniel Pfurtscheller, Ena Suppan, Gerhard Pichler, Bernhard Schwaberger
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