title: Epidural analgesia in labour and neonatal respiratory distress: a case-control study.
abstract: BACKGROUND
  Epidural analgesia is the commonest mode for providing pain relief in labour, with a combination of bupivacaine and fentanyl most often used in practice.
  
  
  OBJECTIVE
  To test whether late-preterm and term neonates exposed to opioids in epidural analgesia in labour are more likely to develop respiratory distress in the immediate neonatal period.
  
  
  METHODS
  A case-control study was conducted of singleton infants born during January 2006 to December 2010. Cases were neonates ≥34 weeks gestation, who developed respiratory distress within 24 h of life requiring supplemental oxygen ≥2 h and/or positive pressure ventilation in the neonatal intensive care unit. Controls were gestation and site-matched neonates who did not develop any respiratory distress within the same period. The information on exposure to epidural analgesia and on potential confounding variables was obtained from the standardised delivery record, routinely filled out on all women admitted to the labour wards.
  
  
  RESULTS
  In our study, 206 cases and 206 matched controls were enrolled. Exposure to epidural analgesia was present in 146 (70.9%) cases as compared with 131 (63.6%) of the controls. The association between exposure to epidural analgesia and respiratory distress in neonates was statistically significant upon adjustment for all potential confounders (adjusted OR: 1.75, 95% CI 1.03 to 2.99; p = 0.04). When data was separately analysed for term and late-preterm infants, the results were consistent across these subpopulations, showing no interaction effect.
  
  
  CONCLUSIONS
  Late-preterm and term infants exposed to maternal epidural analgesia in labour are more likely to develop respiratory distress in the immediate neonatal period.
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Alberta, , Edmonton, Alberta, Canada.
authors.forename: Manoj
authors.initials: M
authors.lastname: Kumar
authors.forename: Sue
authors.initials: S
authors.lastname: Chandra
authors.forename: Zainab
authors.initials: Z
authors.lastname: Ijaz
authors.forename: Ambikaipakan
authors.initials: A
authors.lastname: Senthilselvan
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D007363:Intensive Care Units, Neonatal; D007743:Labor, Obstetric / Q000502:physiology*; D011247:Pregnancy; D012044:Regression Analysis; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid
keywords: case-control study; epidural analgesia; respiratory distress