Obstetric risk factors for poor neonatal adaptation at birth

Francesca Crovetto, Monica Fumagalli, Agnese De Carli, Giulia Maria Baffero, Silvia Nozza, Francesca Dessimone, Patrizia Vergani, Luigi Fedele, Fabio Mosca, Barbara Acaia

Research output: Contribution to journalArticlepeer-review


Purpose: To identify obstetric risk factors of delivering a neonate with poor neonatal adaptation at birth. Material and methods: Nested case–control study. Poor neonatal adaptation was defined for presence of at least: umbilical cord artery pH <7.10, base deficit ≥12 mmol/L, Apgar score at 1′ ≤5. Controls were selected from the same population and matched with cases. The association between clinical parameters and poor neonatal adaptation was analyzed by logistic regression. Results: One hundred and thirty three women (2.1% of all live births) with a neonate presenting a poor neonatal adaptation were matched with 133 subsequent controls. Significant contributions for the prediction of poor neonatal adaptation were provided by maternal age ≥35 years (p ≤ .001, odds ratio (OR) 3.9 [95%CI: 2.3–6.8]), nulliparity (p ≤ .001, OR 3.3 [95%CI: 1.8–6]), complications during pregnancy (p = .032, OR 2.2 [95%CI: 1.1–4.4]), gestational age at delivery <37 weeks (p = .008, OR 5.2 [95%CI: 1.5–17.8]) and cardiotocography category II or III (p ≤ .001, OR 36.3 [95%CI: 16.5–80.1]). The receiver operative characteristic curve was 0.91 [95%CI: 0.87–0.95], and detection rates 82.7% and 89.5% at 10% and 20% of false positive rates, respectively. Conclusions: Several obstetric risk factors before and during labor can identify a subgroup of newborns at higher risk of a poor neonatal adaptation at birth.

Original languageEnglish
Pages (from-to)2429-2435
Number of pages7
JournalJournal of Maternal-Fetal and Neonatal Medicine
Issue number18
Publication statusPublished - 2018


  • Apgar
  • blood cord analysis
  • CTG tracing
  • neonatal acidosis
  • neonatal adaptation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynaecology


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