Intrapartum Temperature Elevation, Epidural Use, and Adverse Outcome in Term Infants

Author:

Greenwell Elizabeth A.1,Wyshak Grace2,Ringer Steven A.3,Johnson Lise C.3,Rivkin Michael J.4,Lieberman Ellice15

Affiliation:

1. Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts

2. Departments of Biostatistics, Global Health and Population, and Psychiatry, Harvard School of Public Health and Harvard Medical School, Boston, Massachusetts

3. Department of Newborn Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts

4. Departments of Neurology, Radiology and Psychiatry, Children’s Hospital and Harvard Medical School, Boston, Massachusetts

5. Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts

Abstract

OBJECTIVES: To examine the association of intrapartum temperature elevation with adverse neonatal outcome among low-risk women receiving epidural analgesia and evaluate the association of epidural with adverse neonatal outcome without temperature elevation. METHODS: We studied all low-risk nulliparous women with singleton pregnancies ≥37 weeks delivering at our hospital during 2000, excluding pregnancies where infants had documented sepsis, meningitis, or a major congenital anomaly. Neonatal outcomes were compared between women receiving (n = 1538) and not receiving epidural analgesia (n = 363) in the absence of intrapartum temperature elevation (≤99.5°F) and according to the level of intrapartum temperature elevation within the group receiving epidural (n = 2784). Logistic regression was used to evaluate neonatal outcome while controlling for confounders. RESULTS: Maternal temperature >100.4°F developed during labor in 19.2% (535/2784) of women receiving epidural compared with 2.4% (10/425) not receiving epidural. In the absence of intrapartum temperature elevation (≤99.5°F), no significant differences were observed in adverse neonatal outcomes between women receiving and not receiving epidural. Among women receiving epidural, a significant linear trend was observed between maximum maternal temperature and all neonatal outcomes examined including hypotonia, assisted ventilation, 1- and 5-min Apgar scores <7, and early-onset seizures. In regression analyses, infants born to women with fever >101°F had a two- to sixfold increased risk of all adverse outcomes examined. CONCLUSIONS: The proportion of infants experiencing adverse outcomes increased with the degree of epidural-related maternal temperature elevation. Epidural use without temperature elevation was not associated with any of the adverse outcomes we studied.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

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