title: Labour epidural analgesia and anti-infectious management of the neonate: a meta-analysis.
abstract: BACKGROUND
  A known side effect of labour epidural analgesia (EDA) is maternal fever. It is unclear whether this has effects on the anti-infectious management of the neonate.
  
  
  METHODS
  A systematic literature search and a hand search of abstract publications were conducted. Studies reporting sepsis evaluation or antibiotic treatment were further assessed. For meta-analysis, risk ratio (RR) and 95% confidence interval (CI) were calculated using the random effects model.
  
  
  RESULTS
  Five relevant articles reporting on 4667 parturients were identified; three were observational studies and two were randomised controlled trials (RCT). The RR for sepsis workup of all studies analysed together was 2.58 (95% CI, 1.06-6.27, P=0.04). The RR for antibiotic treatment of the neonate was 2.76 (95% CI, 1.20-6.31, P=0.02). When considering the RCTs alone, the RRs for sepsis evaluation and antimicrobial treatment were still significantly elevated.
  
  
  CONCLUSIONS
  Our data suggest that EDA-related maternal hyperthermia results in an increased likelihood of sepsis workup and antibiotic treatment of the infant. A crucial question is whether EDA-related maternal hyperthermia is truly infectious. If not, administration of antibiotics would not be justified and may be dangerous.
authors.forename: Michael
authors.initials: M
authors.lastname: Heesen
authors.forename: Sven
authors.initials: S
authors.lastname: Klöhr
authors.forename: Rolf
authors.initials: R
authors.lastname: Rossaint
authors.forename: Sebastian
authors.initials: S
authors.lastname: Straube
authors.forename: Mark
authors.initials: M
authors.lastname: Van de Velde
mesh_terms: D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000900:Anti-Bacterial Agents; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric
chemical_list: D000900:Anti-Bacterial Agents