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Intrapartum temperature elevation, epidural use, and adverse outcome in term infants
Elizabeth A Greenwell1, Grace Wyshak, Steven A Ringer
1Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA. greenwell.ea@comcast.net
Pediatrics
|February 1, 2012
Summary
Epidural analgesia is linked to adverse neonatal outcomes only when it causes maternal fever. Without fever, epidural use showed no increased risk for negative infant outcomes.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Health
- Anesthesiology
Background:
- Intrapartum maternal temperature elevation is a known risk factor for adverse neonatal outcomes.
- The role of epidural analgesia in this association requires further clarification, particularly in low-risk populations.
Purpose of the Study:
- To investigate the relationship between intrapartum temperature elevation and adverse neonatal outcomes in women receiving epidural analgesia.
- To assess the impact of epidural analgesia on neonatal outcomes in the absence of maternal temperature elevation.
Main Methods:
- A retrospective study of low-risk nulliparous women delivering singleton pregnancies at ≥37 weeks.
- Comparison of neonatal outcomes between women receiving and not receiving epidural analgesia without temperature elevation (≤99.5°F).
- Analysis of neonatal outcomes based on the degree of maternal temperature elevation in women receiving epidural analgesia, using logistic regression.
Main Results:
- Maternal fever (>100.4°F) was significantly more common in women receiving epidural analgesia (19.2%) compared to those not receiving it (2.4%).
- No significant differences in adverse neonatal outcomes were found between groups in the absence of maternal temperature elevation (≤99.5°F).
- Among women receiving epidural, increasing maternal temperature showed a linear trend with adverse neonatal outcomes, including hypotonia, need for assisted ventilation, low Apgar scores, and seizures. Infants of mothers with fever >101°F had a 2-6 fold increased risk.
Conclusions:
- The risk of adverse neonatal outcomes increases with the degree of maternal temperature elevation associated with epidural use.
- Epidural analgesia, when not accompanied by maternal temperature elevation, is not associated with adverse neonatal outcomes.
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