title: Intrapartum temperature elevation, epidural use, and adverse outcome in term infants.
abstract: 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 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.
authors.affiliation: Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA. greenwell.ea@comcast.net
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Greenwell
authors.forename: Grace
authors.initials: G
authors.lastname: Wyshak
authors.forename: Steven A
authors.initials: SA
authors.lastname: Ringer
authors.forename: Lise C
authors.initials: LC
authors.lastname: Johnson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rivkin
authors.forename: Ellice
authors.initials: E
authors.lastname: Lieberman
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000175:diagnosis / Q000209:etiology; D016022:Case-Control Studies; D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology; D015331:Cohort Studies; D004569:Electroencephalography; D020936:Epilepsy, Benign Neonatal / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis / Q000209:etiology; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000209:etiology; D008297:Male; D009460:Neurologic Examination; D007744:Obstetric Labor Complications / Q000175:diagnosis* / Q000209:etiology*; D011247:Pregnancy; D012044:Regression Analysis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric