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Non-urgent caesarean delivery increases the need for ventilation at birth in term newborn infants
  1. Maria Fernanda Branco de Almeida1,2,
  2. Ruth Guinsburg1,2,
  3. José Orleans da Costa2,3,
  4. Lêni Márcia Anchieta2,4,
  5. Lincoln Marcelo Silveira Freire4,5,
  6. Dioclécio Campos Jr5,6
  1. 1Neonatal Division, Federal University of São Paulo, São Paulo, Brazil
  2. 2Neonatal Resuscitation Program, Brazilian Pediatric Society, São Paulo, Brazil
  3. 3Department of Epidemiology, Medical School of Barbacena, Barbacena, Brazil
  4. 4Department of Pediatrics, Federal University of Minas Gerais, Minas Gerais, Brazil
  5. 5Brazilian Pediatric Society, São Paulo, Brazil
  6. 6Department of Pediatrics, Brasília University, Brasília, Brazil
  1. Correspondence to Ruth Guinsburg, Rua Vicente Felix 77, apt 09, São Paulo, SP, Brazil, 01410-020; ruthgbr{at}


Objective To compare the need for positive pressure ventilation (PPV) by bag and mask and by bag and endotracheal tube in newly born term infants with vertex presentation delivered by non-urgent caesarean section under regional anaesthesia or non-instrumental vaginal delivery.

Design Cross-sectional study.

Setting 35 public hospitals in 20 Brazilian state capitals.

Patients 6929 inborn infants without congenital anomalies, with gestational ages from 370/7 to 416/7 weeks with vertex presentation, born between 1 and 30 September 2003.

Intervention Non-urgent caesarean versus non-instrumental vaginal delivery. Non-urgent caesarean was defined as delivery occurring in the absence of prolapsed cord, third trimester haemorrhage, failure of labour induction, fetal distress or non-clear amniotic fluid.

Main outcome measures PPV with bag and mask and with bag and endotracheal tube. Both outcomes were adjusted for potential confounding variables by logistic regression analysis.

Results 2087 infants were born by non-urgent caesarean and 4842 by non-instrumental vaginal delivery. Non-urgent caesarean delivery under regional anaesthesia compared to vaginal delivery under local or no anaesthesia increased the risk of bag and mask ventilation (OR 1.42, 95% CI 1.07 to 1.89) adjusted for number of gestations, maternal hypertension and birth weight. Ventilation with bag and endotracheal tube was associated only with low birth weight, adjusted for delivery mode and twin gestation.

Conclusions Term neonates with vertex presentation and clear amniotic fluid born by non-urgent caesarean section under regional anaesthesia need to be assisted at birth by health professionals skilled in PPV.

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  • Funding The Brazilian Society of Pediatrics Foundation supported this study.

  • Competing interests None.

  • Ethics approval The institutional review boards of the Federal University of São Paulo and the clinical board of each participating institution approved the study protocol.

  • Provenance and peer review Not commissioned; externally peer reviewed.