What is the clinical evidence from this study?

Study design: Cohort. Population: Cesarean section (neonatal outcomes) (n=997). Intervention: General anesthesia vs. Spinal anesthesia. Primary outcome: Respiratory distress syndrome (RDS) (OR 1.835, p=0.038).

What question did this study set out to answer?

The study investigates the impact of general versus spinal anesthesia on neonatal outcomes during cesarean sections.

June 14, 2026Open Access

Mode of Anesthesia During Cesarean Section and Neonatal Morbidity and Mortality: A Cohort Study

Resultado clave

General anesthesia during cesarean section was associated with a significantly higher risk of neonatal respiratory distress syndrome compared to spinal anesthesia (42.3% vs 35.5%, OR 1.835).

Puntos clave

The study investigates the impact of general versus spinal anesthesia on neonatal outcomes during cesarean sections.
Conducted a retrospective cohort study.
Included 997 neonatal admissions from elective or emergency cesarean sections from 2017 to 2021.
Grouped neonates based on mode of maternal anesthesia: general anesthesia (GA) or spinal anesthesia (SA).
Spinal anesthesia associated with better Apgar scores (8.56 vs 8.16, P=0.0001) and less respiratory distress (35.5% vs 42.3%, P=0.02).
General anesthesia linked to higher neonatal death rates (10.8% vs 4%, P=0.0001).
Multivariate analysis confirmed that type of anesthesia affects respiratory distress syndrome and other neonatal complications.

Diseño del estudio

Tipo

Cohort (n=997)

Multicéntrico

PICO estructurado

Does spinal anesthesia improve neonatal outcomes compared to general anesthesia in neonates born via cesarean section?

Población

997 neonates admitted to the NICU following maternal elective or emergency cesarean section, comparing outcomes between spinal and general anesthesia.

Exposición

Spinal anesthesia (SA) using 0.5% heavy bupivacaine and fentanyl

Comparador

General anesthesia (GA) using propofol, rocuronium, and isoflurane

Resultado

Difference between spinal anesthesia and general anesthesia in regard to neonatal outcomeshard clinical

General anesthesia during cesarean section is associated with worse neonatal outcomes, including higher mortality and respiratory distress syndrome, compared to spinal anesthesia, though this may be confounded by its use in higher-grade emergencies.

Resultado numérico

Odds Ratio: 1.835

Tasa de eventos absoluta: 42.3% vs 35.5%

valor p: p=0.038

Limitaciones

Retrospective design
Study population was restricted to NICU-admitted neonates
Majority of patients receiving general anesthesia underwent emergency cesarean sections, introducing confounding by indication
Maternal comorbidities and obstetric complications may largely account for the observed outcome differences

Resumen

Alaâa Alhowary,1 Omar Altal,2 Wasim Khasawneh,3 Saif Aldin Naif Rawabdeh,3 Rania Al-Bataineh,4 Anas Alrusan,1 Tareq Khaldoon Bashaireh,4 Lana Haddad,5 Rola Madain,2 Ahmed H Al Sharie4,6 1Department of Anesthesia and Pain Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 21110, Jordan; 2Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan; 3Department of Pediatrics, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan; 4Faculty of Medicine, Jordan University of Science and Technology, Irbid, 21110, Jordan; 5Department of Pediatrics, University of Utah, Salt Lake, UT, 84112, USA; 6Department of Internal Medicine, Southeast Health, Dothan, AL, USACorrespondence: Alaâa Alhowary, Department of Anesthesiology, Faculty of Medicine Jordan University of Science and Technology, P. O. Box: 3030, Irbid, 22110, Jordan, Tel +962791595219, Email alaacom78@yahoo.comBackground: The influence of obstetric anesthesia on neonates is still under investigation. We aimed to investigate the influence of type of anesthesia; either general anesthesia (GA) or spinal anesthesia (SA); during elective or emergency cesarean section (CS) on neonatal outcomes.Methods: A retrospective cohort study was conducted and all neonatal admissions to the neonatal intensive care unit for mothers who underwent elective or emergency CS as the mode of delivery during the period from 2017 to 2021 were enrolled in the study. The primary outcome of the study was to investigate the difference between SA and GA. The enrolled cohort was divided into two groups: GA and SA groups.Results: A total of 997 patients were included in the study cohort. Among these, 628 patients underwent CS under SA. On univariate analysis, it was revealed that SA was associated with better Apgar score (8.56 Â± 0.04 vs 8.16 Â± 0.05, P =0.0001), less incidence of respiratory distress syndrome (RDS) (35.5% vs 42.3%, P =0.02), intraventricular hemorrhage (IVH) (0.8% vs 13.6%, P =0.0001), and neonatal thrombocytopenia (12.4% vs 17.3%, P =0.021). Moreover, GA was linked to higher mortality rates (10.8% vs 4%, P =0.0001) and more birth depression (10.6% vs 4.3%, P =0.0001). On the other hand, GA was related to less incidence of transient tachypnea of the newborn (TTN) (6.2% vs 12.6%, P =0.001). On multivariate logistic regression analysis, mode of anesthesia was related to RDS, TTN, IVH, birth depression and neonatal death.Conclusion: GA use may be related to more adverse and worse neonatal outcomes. This is related to the utilization of GA more frequently in higher-grade emergencies and is associated with more adverse baseline predictors including lower gestational age, lower birth weight, and greater obstetric complications. SA could offer a localized effect for the anesthetic drugs. Further prospective trials are needed to justify the risk of both types of anesthesia.Keywords: Apgar score, general anesthesia, neonatal intensive care unit, respiratory distress syndrome, spinal anesthesia

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