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. 2012 Feb;129(2):e447-54.
doi: 10.1542/peds.2010-2301. Epub 2012 Jan 30.

Intrapartum temperature elevation, epidural use, and adverse outcome in term infants

Elizabeth A Greenwell  1 , Grace Wyshak, Steven A Ringer, Lise C Johnson, Michael J Rivkin, Ellice Lieberman
Affiliations

Intrapartum temperature elevation, epidural use, and adverse outcome in term infants

Elizabeth A Greenwell et al. Pediatrics. 2012 Feb.

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.

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Figures

FIGURE 1
FIGURE 1
Occurrence of neonatal outcomes according to maximum intrapartum temperature among women who used epidural analgesia.
See this image and copyright information in PMC

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