• A Burguet, O Pez, B Debaene, M Untersteller, G Bettinger, S Kayemba-Kays, G Thiriez, M-F Bouthet, P Sanyas, A Menget, B Mulin, R Maillet, P Boisselier, F Pierre, and J-B Gouyon.
• CIE1, Inserm, Centre d'Investigation Clinique, d'Epidémiologie Clinique et d'Essais Cliniques, Université de Bourgogne, CHRU de Dijon, 21000 Dijon, France. antoine.burguet@chu-dijon.fr
• Arch Pediatr. 2009 Dec 1; 16 (12): 1547-53.

ObjectiveTo assess the risk of tracheal intubation at birth in very premature neonates related to the type of maternal anesthesia in case of elective cesarean.Population And MethodsAll 219 live-born very premature neonates (28-32 weeks of gestation), delivered after an elective cesarean in the 27 maternity wards of 2 French semi-rural neonatal networks. Eighty-three percent (182/219) were delivered in level III maternity wards in university hospitals.ResultsOf the very preterm neonates, 33.3% (73/219) were intubated in the delivery room, either for respiratory distress syndrome or a low APGAR score. Very preterm neonates delivered after maternal general anesthesia were more often intubated than those delivered after spinal anesthesia (48.7% vs 25.2%; OR: 2.8; 95% CI: 1.8-5.1). The risk of intubation related to maternal general anesthesia remained statistically significant after an adjustment for gestational age, fetal growth retardation, respiratory distress syndrome, type of maternity ward, and a propensity score that took into account maternal sociodemographic characteristics and the causes of very preterm birth (aOR: 3.4; 95% CI: 1.4-8.2). The risk of intubation related to general anesthesia was lower after adjusting for the 5-min APGAR score (aOR: 2.8; 95% CI: 1.0-7.3).ConclusionVery preterm neonates delivered after cesarean with general anesthesia require tracheal intubation in the delivery room more often than those delivered with spinal anesthesia. This study cannot assess a causal link between anesthesia and the need for neonatal intubation. However, neonatologists have to be aware of the type of maternal anesthesia because it may interfere with the non-invasive ventilation support policy of the very preterm neonate.

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