Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 08 29 1671 1671 Ali Dabbagh Anesthesiology Research Center, Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Marzieh Shahrabi Department of Anesthesiology, Shahid Modarres Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Naseer Waheeb-Mohammed Department of Anesthesiology, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ebtehaj Heshmatkhah Department of Obstetrics and Gynecology, Valiasr Private Hospital, Qom, Iran. Dariush Abtahi Department of Anesthesiology, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Shideh Ariana Department of Gynecology and Oncology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Seyedeh Samira Abdollahzadeh Department of Gynecology and Oncology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2026 06 29 2026 07 11 Background: The choice of anesthetic technique for cesarean section remains a critical consideration due to potential impacts on neonatal well-being. This study aimed to compare immediate neonatal respiratory outcomes, specifically the incidence of neonatal apnea, between general anesthesia (GA) and spinal anesthesia (SA). Methods: We conducted a prospective observational cohort study at a tertiary academic medical center. Maternal and neonatal variables were collected for cesarean deliveries under GA or SA. The primary endpoint was the incidence of neonatal apnea. Secondary outcomes included respiratory distress, requirements for positive pressure ventilation (PPV), and NICU admission. Data were analyzed using SPSS 26.0, employing chi-square, Mann-Whitney U tests, and multivariable binary logistic regression to adjust for potential confounders. Results: A total of 100 cases were analyzed. While neonatal apnea was numerically higher in the GA group (14% vs. 10% in SA), and PPV was required exclusively in neonates born under GA (p = 0.012), multivariable analysis demonstrated that anesthetic technique was not an independent predictor of neonatal apnea (OR 1.465, p = 0.538). Conversely, acute fetal compromise (OR 4.567, p = 0.024) and the primary indication for cesarean delivery (adjusted OR 7.03, p = 0.022) were identified as independent risk factors for neonatal apnea. No statistically significant differences were observed in umbilical arterial pH, Apgar scores, or NICU admission rates. Conclusion: Cesarean indication, especially acute fetal compromise, was the main determinant of neonatal apnea and early respiratory adaptation. Although positive pressure ventilation occurred more often after general anesthesia, anesthetic technique was not an independent predictor after adjustment. These findings suggest that underlying maternal–fetal conditions may influence neonatal respiratory outcomes more than the anesthetic method itself. https://aacc.tums.ac.ir/index.php/aacc/article/view/1671