Work

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

Year: 2026

Type: article

Abstract: Objective Non-invasive respiratory support during immediate postnatal transition is common in caesarean-delivered late preterm and term neonates yet distinguishing those, who will require neonatal intensive care unit (NICU) admission and those who will stabilise with initial respiratory support, remains challenging. This exploratory study assessed whether clinical parameters obtained within the first 15 min after birth are associated with NICU admission for ongoing respiratory support lasting beyond 60 min.Design and setting Post hoc analysis of prospectively collected data from three observational studies (2018–2024) conducted at a single tertiary NICU (Medical University Graz).Patients A total of 105 neonates with a gestational age (GA) ≥34 weeks delivered by caesarean section and requiring non-invasive respiratory support within 15 min after birth were eligible.Results Neonates admitted to the NICU for ongoing respiratory support (NICU group, n=30, GA 35 4/7 (344/7–380/7)) were compared with those who stabilised in the delivery room (non-NICU group, n = 75, GA 384/7 (374/7–390/7)). Neonates in the NICU group were significantly more often male, had lower GA, birth weight, 10 min Apgar scores, peripheral arterial oxygen saturation (SpO2), SpO2/fraction of inspired oxygen ratio (S/F ratio) and higher heart rates 15 min after birth. In multivariable regression, lower GA (p = 0.010) and a lower S/F ratio at 15 min (p < 0.001) were independently associated with NICU admission.Conclusion Among this cohort of caesarean-delivered late preterm and term neonates requiring non-invasive respiratory support in the first 15 min after birth, lower GA and a lower S/F ratio at 15 min were independently associated with subsequent NICU admission. These findings identify candidate early clinical indicators; larger prospective studies are needed to validate their predictive value and determine their role in clinical decision-making.

Source: BMJ Paediatrics Open

DOI: 10.1136/bmjpo-2026-004472