Stuck in transition - admission to the neonatal intensive care unit after shoulder dystocia: analysis of risk factors and assessment of postnatal care

BACKGROUND: This study aimed to assess frequency and causes of neonatal intensive care unit (NICU) admissions in neonates with shoulder dystocia (SD). METHODS: A retrospective analysis of 116 SD cases at a tertiary perinatal center was performed (2007 - 2023). Maternal and neonatal parameters were evaluated in relation to NICU admission. RESULTS: Seventeen neonates (14.7%) were admitted to the NICU. All showed respiratory distress; five required cardiopulmonary resuscitation, two of them received therapeutic hypothermia for hypoxic-ischemic encephalopathy. Compared to non-admitted infants, NICU neonates had significantly lower umbilical artery pH and base deficit, lower Apgar scores, and higher rate of birth injuries. They also had a significantly longer median head-to-body delivery interval (HBDI, 5.0 vs. 2.0 minutes, p < 0.0001). No neonatal deaths occurred before discharge. CONCLUSION: SD can lead to severe postnatal adaptation problems in newborns, requiring timely and structured interdisciplinary management. Our findings suggest that a HBDI of ≥ five minutes serve as a clinically applicable parameter to identify neonates at increased risk of NICU admission and appears to be associated with a higher likelihood of brachial plexus injury. Furthermore, greater fetal size, reflected by higher birth weight and body surface area, was related to the occurrence of birth injuries overall, underscoring the relevance of both extraction time and fetal dimensions for postnatal outcomes after SD.