Online Program

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

Tuesday, November 5, 2013

Elizabeth Greenwell, ScD, University of Colorado Denver, Aurora, CO
Grace Wyshak, PhD, Department of Biostatistics, Harvard School of Public Health, Boston, MA
Steven Ringer, MD, PhD, Department of Newborn Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
Lise Johnson, MD, Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA
Michael Rivkin, MD, Department of Neurology, Children's Hospital Boston, Boston, MA
Ellice Lieberman, MD, DrPH, Department of Social and Behavioral Sciences, Department of Epidemiology, Harvard School of Public Health, Harvard Medical School, Boston, MA
Objective: 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 the year 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 maternal 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 19.3% (537/2784) of women receiving epidural analgesia compared to 2.4% (10/425) not receiving epidural (P<.0001). 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 minute Apgar scores <7, and early-onset seizures. In regression analyses, infants born to women with fever >101°F had a 2-6 fold increased risk of all adverse neonatal 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.

Learning Areas:

Clinical medicine applied in public health
Provision of health care to the public

Learning Objectives:
Identify five potential adverse neonatal outcomes associated with epidural use and intrapartum temperature elevation.

Keyword(s): Pregnancy, Perinatal Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: My scientific interests involve examining perinatal indicators of adverse maternal and neonatal outcomes. This was my topic of research during my dissertation, and I was principal investigator and first author on this abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.