Perinatology.  2021 Dec;32(4):184-192. 10.14734/PN.2021.32.4.184.

Maternal and Fetal Risk Factors Associated with Neonatal Intensive Care Unit Admis sion in Term Neonates

• Ku TI
• Kim YN
• Im DH
• Kim YS
• Kim DH
• Byun JM
• Jeong DH

• KMID: 2524273
• DOI: http://doi.org/10.14734/PN.2021.32.4.184

Abstract

Objective
This study aimed to evaluate the risk factors associated with neonatal intensive care unit (NICU) admission in term neonates and to provide necessary data for antenatal counseling.
Methods
This retrospective case-control study was conducted with 643 singleton pregnancies with term delivery at Inje University Busan Paik Hospital from 2017 to 2019. Patients were divided into the NICU admission and nursery groups. Maternal, antepartum, intrapartum, and placental factors were compared between the 2 groups to evaluate the risk factors for the NICU admission. Neonatal outcomes were analyzed as well.
Results
NICU-admitted neonates had lower birth weight (2,971±597 vs. 3,142±418 g, P<0.001), higher incidence of fetal growth restriction (FGR) (21.6% vs. 0.2%, P<0.001), lower Apgar score at 5 minutes (2.7% vs. 0%, P=0.001), and higher incidence of respiratory distress syndrome (23.9%, n=53). Fetal growth restriction (FGR) was the greatest risk factor for the NICU admission (odds ratio [OR], 126.98; 95% confidence interval [CI], 17.17-939.17). Maternal pre-gestational and gestational diabetes mellitus with insulin use were great risk factors for the NICU admission (OR, 33.74; 95% CI, 4.36-260.92 for pre-gestational diabetes; and OR, 24.61; 95% CI, 3.02-200.07 for gestational diabetes, respectively). Emergent cesarean delivery due to prolonged 1st stage of labor and vaginal delivery had similar risk for the NICU admission (OR, 2.18; 95% CI, 1.26-3.77; and OR, 1.85; 95% CI, 1.18-2.91, respectively).
Conclusion
Pregnancies that are complicated with FGR, pre-gestational and gestational diabetes mellitus with insulin use, and emergent cesarean delivery due to prolonged 1st stage labor may have higher risk for NICU admission, even among term neonates. Therefore, pregnancies with the above risk factors are advised for possible NICU admission during antenatal counseling.

Keyword

Neonatal intensive care units; Fetal growth restriction; Gestational diabetes mellitus