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

Q: How many shoulder dystocia cases were analyzed, and over what period?

A retrospective analysis covered 116 shoulder dystocia cases treated at a tertiary perinatal center from 2007 to 2023.

Q: What proportion of neonates with shoulder dystocia were admitted to the NICU?

Seventeen neonates (14.7%) were admitted to the NICU, and all showed respiratory distress.

Q: Which marker related to increased NICU admission risk after shoulder dystocia?

The head-to-body delivery interval (HBDI) of at least five minutes was suggested as a clinically applicable parameter associated with higher NICU admission risk and a greater likelihood of brachial plexus injury.

Sep 30, 2026

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Background: This retrospective study evaluates how often neonates with shoulder dystocia require NICU admission and identifies associated maternal and neonatal causes. Methods: 116 shoulder dystocia cases from a tertiary perinatal center (2007–2023) were analyzed by comparing NICU-admitted and non-admitted infants. Results: Seventeen neonates (14.7%) were admitted, showing respiratory distress; some required cardiopulmonary resuscitation and therapeutic hypothermia for HIE. Compared with non-admitted infants, NICU cases had lower umbilical artery pH and base deficit, lower Apgar scores, higher birth injury rates, and a longer HBDI. No neonatal deaths occurred before discharge. Conclusion: A HBDI ≥ five minutes may help identify increased NICU risk and relate to brachial plexus injury; larger fetal size also correlated with birth injuries and postnatal outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Background

Definition and incidence of shoulder dystocia

Risk factors for shoulder dystocia

Birth injury and perinatal physiology

Rahn et al. Maternal Health, Neonatology and Perinatology (2026) 12:1 [https://doi.org/10.1186/s40748-025-00244-5](https://doi.org/10.1186/s40748-025-00244-5) Maternal Health, Neonatology and Perinatology RESEARCH Open Access Stuck in transition-admission to the neonatal intensive care unit after shoulder dystocia: analysis of risk factors and assessment of postnatal care Alexandros Rahn1*, Carolin Böhne 1, Bettina Bohnhorst 1, Sabine Pirr1, Corinna Peter 1, Svea Kleiner2, Charlotte Mindermann3, Patrick Galland4, Vivien Dütemeyer5, Constantin von Kaisenberg5 and Lars Brodowski5 Abstract 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. Keywords Shoulder dystocia, Neonatology, Obstetrics, Cardiopulmonary resuscitation, Birth injury *Correspondence: Alexandros Rahn [rahn.alexandros@mh-hannover.de](rahn.alexandros@mh-hannover.de) 1Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany 2Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Hannover, Germany 3Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany 4Department of Child and Adolescent Psychiatry, Children’s Hospital Auf der Bult, Hannover, Germany 5Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/.)[.](http://creativecommons.org/licenses/by/4.0/.) Rahn et al. Maternal Health, Neonatology and Perinatology (2026) 12:1 Page 2 of 9 Background Shoulder dystocia (SD) is a rare but serious obstetric complication, occurring

FAQs

How many shoulder dystocia cases were analyzed, and over what period?

A retrospective analysis covered 116 shoulder dystocia cases treated at a tertiary perinatal center from 2007 to 2023.

What proportion of neonates with shoulder dystocia were admitted to the NICU?

Seventeen neonates (14.7%) were admitted to the NICU, and all showed respiratory distress.

Which marker related to increased NICU admission risk after shoulder dystocia?

The head-to-body delivery interval (HBDI) of at least five minutes was suggested as a clinically applicable parameter associated with higher NICU admission risk and a greater likelihood of brachial plexus injury.

Sep 30, 2026

Uploaded by Elsa