Authors: Langer, Sarah et al.
Anesthesiology October 2025 | DOI: 10.1097/ALN.0000000000005785
This meta-analysis of randomized controlled trials compared neonatal outcomes following cesarean delivery performed under regional anesthesia (spinal, epidural, or combined spinal-epidural) versus general anesthesia. Although regional techniques are widely preferred for maternal safety and recovery, their comparative effect on neonatal well-being has remained uncertain.
The review included 36 randomized trials encompassing 3,456 neonates. Among these, 1,980 deliveries were conducted under regional anesthesia and 1,476 under general anesthesia. Primary neonatal outcomes included Apgar scores at 1 and 5 minutes, need for respiratory support, and admission to the neonatal intensive care unit (NICU).
Pooled analysis demonstrated that regional anesthesia was associated with higher Apgar scores—by 0.58 points at 1 minute (95% CI 0.36–0.79, P < 0.001) and 0.09 points at 5 minutes (95% CI 0.05–0.13, P < 0.001). Neonates born under regional anesthesia were also less likely to require respiratory support (risk ratio = 0.62; 95% CI 0.40–0.94; P = 0.03). However, no significant difference was observed in NICU admission rates (risk ratio = 0.75; 95% CI 0.46–1.21; P = 0.24).
Despite these favorable neonatal findings, most included trials exhibited high or unclear risk of bias, limiting certainty of the estimates. The authors emphasize the need for modern, well-powered studies assessing not only short-term indices like Apgar scores but also long-term neurodevelopmental outcomes related to anesthetic exposure.
What You Should Know
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Regional anesthesia for cesarean delivery yields modestly higher neonatal Apgar scores and reduces the need for immediate respiratory support compared with general anesthesia.
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No difference was detected in NICU admissions between anesthesia types.
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Evidence quality is limited, and future research should explore neurodevelopmental and longer-term neonatal outcomes.
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