Factors Associated with Adverse Early Neonatal Composite Outcomes in Neonates Delivered by Cesarean Section Under General Anesthesia: A Single-Center Retrospective Cohort Study

Background: Neonatal outcomes after cesarean delivery under general anesthesia reflect maternal, obstetric, fetal, and perioperative circumstances. We examined factors associated with a study-defined adverse early neonatal composite outcome. Methods: This single-center retrospective cohort included 791 neonates delivered under general anesthesia between 1 June 2021 and 30 June 2026. The composite comprised a 1 min Apgar score ≤ 3, a 5 min Apgar score ≤ 5, umbilical arterial pH < 7.20, or hypoxic-ischemic encephalopathy (HIE). Binomial generalized estimating equations accounted for maternal clustering. Sensitivity analyses examined emergency deliveries, a 5 min Apgar score ≤ 7, alternative pH thresholds, and a composite excluding pH. Results: The primary composite occurred in 69 neonates (8.7%). Placental disorders (adjusted odds ratio [aOR], 3.913; 95% confidence interval [CI], 1.883–8.131), fetal distress (aOR, 4.403; 95% CI, 2.331–8.316), and gestational age < 32 weeks (aOR, 3.792; 95% CI, 1.852–7.765) were associated with the primary outcome. These associations persisted in measured-pH analyses using thresholds of <7.20 and <7.10. Preterm birth and scarred uterus were associated with a 5 min Apgar score ≤ 7. Conclusions: Selected obstetric and gestational-age factors were associated with adverse early neonatal status. The heterogeneous composite, missing pH, limited events, and retrospective variable selection constrain interpretation; these associations do not establish perinatal asphyxia or causal effects.