Effect of labor epidural analgesia with and without fentanyl on infant breast-feeding: a prospective, randomized, double-blind study.
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.
Beilin
Yaakov
Y
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
Bodian
Carol A
CA
Weiser
Jane
J
Hossain
Sabera
S
Arnold
Ittamar
I
Feierman
Dennis E
DE
Martin
Gregory
G
Holzman
Ian
I
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
D000759:Adjuvants, Anesthesia; D005283:Fentanyl