Which Births Are High Risk?: Condition Of Neonates At Birth And Risk Of Intervention Associated With Type Of Delivery And Thickness Of Meconium In The District General Hospital Setting

Aims: To determine which births require a paediatrician in attendance at a District General Hospital, by correlating mode of delivery and meconium thickness with birth condition and intervention risk. Methods: A midwife-entered questionnaire based study of all births in Hinchingbrooke Hospital starting April 2000. Data on type of birth, meconium thickness, Apgar scores, and resuscitation rates was collected. Results: 1210 valid data sets were obtained. Five methods of determining "at risk" births were considered: depression of the Apgar score at 1 minute, increased odds ratio of having an Apgar 0-3 or 4-6 at 1 minute, and the odds ratio of needing intubation or face mask ventilation. All five variables were significantly worse in deliveries with thick meconium, emergency, and crash caesarean sections. Three of the variables were significantly worse in births with thin meconium and with forceps, in two of the variables were significantly worse with ventouse deliveries. The Apgar scores were comparatively (non-significantly) better with elective and semi-elective caesarean sections. Conclusions: With the rationalisation of the paediatric workforce, especially in District General Hospitals, targeting neonatal resuscitation input may be of increasing importance. However, there is a significantly increased risk associated with any child born with thick or thin meconium, assisted deliveries, and emergency and crash caesarean sections. A paediatrician or suitably trained neonatal nurse practitioner should continue to attend these types of delivery. There is no increased risk with elective and semi-elective caesarean sections.