title: Effect of labor epidural analgesia with and without fentanyl on infant breast-feeding: a prospective, randomized, double-blind study.
abstract: BACKGROUND
  The influence of labor epidural fentanyl on the neonate is controversial. The purpose of this study was to determine whether epidural fentanyl has an impact on breast-feeding.
  
  
  METHODS
  Women who previously breast-fed a child and who requested labor epidural analgesia were randomly assigned in a double-blinded manner to one of three groups: (1) no fentanyl group, (2) intermediate-dose fentanyl group (intent to administer between 1 and 150 microg epidural fentanyl), or (3) high-dose epidural fentanyl group (intent to administer > 150 microg epidural fentanyl). On postpartum day 1, the mother and a lactation consultant separately assessed whether the infant was experiencing difficulty breast-feeding, and a pediatrician assessed infant neurobehavior. All women were contacted 6 weeks postpartum to determine whether they were still breast-feeding.
  
  
  RESULTS
  Sixty women were randomly assigned to receive no fentanyl, 59 were randomly assigned to receive an intermediate dose, and 58 were randomly assigned to receive high-dose fentanyl. On postpartum day 1, women who were randomly assigned to receive high-dose fentanyl reported difficulty breast-feeding (n = 12, 21%) more often than women who were randomly assigned to receive an intermediate fentanyl dose (n = 6, 10%), or no fentanyl (n = 6, 10%), although this did not reach statistical significance (P = 0.09). There was also no significant difference among groups in breast-feeding difficulty based on the lactation consultant's evaluation (40% difficulty in each group; P = 1.0). Neurobehavior scores were lowest in the infants of women who were randomly assigned to receive more than 150 microg fentanyl (P = 0.03). At 6 weeks postpartum, more women who were randomly assigned to high-dose epidural fentanyl were not breast-feeding (n = 10, 17%) than women who were randomly assigned to receive either an intermediate fentanyl dose (n = 3, 5%) or no fentanyl (n = 1, 2%) (P = 0.005).
  
  
  CONCLUSIONS
  Among women who breast-fed previously, those who were randomly assigned to receive high-dose labor epidural fentanyl were more likely to have stopped breast-feeding 6 weeks postpartum than woman who were randomly assigned to receive less fentanyl or no fentanyl.
authors.affiliation: Department of Anesthesiology, the Mount Sinai School of Medicine of New York University, Box 1010, One Gustave L. Levy Place, New York, NY 10029-6574, USA. yaakov.beilin@mountsinai.org
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Beilin
authors.forename: Carol A
authors.initials: CA
authors.lastname: Bodian
authors.forename: Jane
authors.initials: J
authors.lastname: Weiser
authors.forename: Sabera
authors.initials: S
authors.lastname: Hossain
authors.forename: Ittamar
authors.initials: I
authors.lastname: Arnold
authors.forename: Dennis E
authors.initials: DE
authors.lastname: Feierman
authors.forename: Gregory
authors.initials: G
authors.lastname: Martin
authors.forename: Ian
authors.initials: I
authors.lastname: Holzman
mesh_terms: D000759:Adjuvants, Anesthesia / Q000009:adverse effects*; D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D001034:Apgar Score; D001942:Breast Feeding; D002849:Chromatography, Gas; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D008875:Middle Aged; D011184:Postoperative Period; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D000759:Adjuvants, Anesthesia; D005283:Fentanyl