Maternal fever and neonatal depression: preliminary observations

The objectives of this study were to determine in term infants: (1) the importance of maternal fever (maternal temperature > 38 degrees C) as a risk factor for neonatal depression and (2) the clinical course of infants admitted to the Neonatal Intensive Care Unit (NICU) born to mothers with fever. For 2 years, 59 (0.24%) of 25,000 term infants had a 5-minute Apgar score < or = 5 and 22 (0.08%) infants were administered chest compressions with or without epinephrine as part of cardiopulmonary resuscitation (CPR) in the delivery room. The perinatal event most commonly associated with a 5-minute Apgar score < or = 5 was maternal fever in 19 infants (32%), with meconium + fetal heart rate (FTHR) abnormalities in 15 (25%), and FTHR abnormalities only in 13 (22%), additional associations (n = 13). By stepwise linear regression analysis, a 5-minute Apgar < or = 5 was related only to the initial infant temperature (p = 0.009, r = 0.33). Maternal fever noted in six infants (27%) was also commonly associated with CPR, as was the presence of meconium + FTHR abnormalities in seven (32%), and FTHR abnormalities only in four (18%). One hundred thirteen (7.5%) of the approximately 1,500 term infants born to mothers with maternal fever were admitted to the NICU. In addition to fever, the labor was complicated by meconium (in 16 infants), meconium + FTHR abnormalities (in 19 infants), and FTHR abnormalities only (in 11 infants). Resuscitative interventions in the delivery room included oxygen only in 43 infants, bag and mask ventilation in 38, continuous positive airway pressure in 10, intubation in 16, and CPR in six infants. Forty-nine infants (43%) had an initial temperature > 38 degrees C including 13 (11%) with an initial temperature > 39 degrees C. Twelve (10%) infants remained intubated on admission and five required ventilator support > 24 hours. One blood culture was positive although all mothers were pretreated with antibiotics. One infant developed hypoxic ischemic encephalopathy including seizures. Maternal fever is the perinatal event most frequently associated with a 5-minute Apgar score < or = 5 and a common association with the need for CPR. Clinicians attending the delivery of a mother with fever should anticipate the potential for neonatal depression; such awareness should facilitate appropriate preparation before delivery and potentially reduce the need for more intensive resuscitation.