title: The effects of epidural/spinal opioids in labour analgesia on neonatal outcomes: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  Epidural/spinal opioids are increasingly used to relieve parturients' pain in labour. Some studies indicate that opioids can induce side effects in neonates, such as respiratory depression and neurobehavioural changes. This meta-analysis aimed to clarify the effects of opioids in labour analgesia on neonates.
  
  
  METHODS
  PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE™ were searched for relevant randomized controlled trials (RCTs). The neonatal data of Apgar scores, Neurological and Adaptive Capacity Scores (NACS), and umbilical cord pH values were extracted. Statistical analyses were carried out using Review Manager 5.2 and Stata(®) 10.
  
  
  RESULTS
  Twenty-one trials with 2,859 participants were included in our meta-analysis. No difference in the incidence of Apgar scores < 7 was shown between the opioid and control groups at one minute (risk difference [RD] 0.0%, 95% confidence interval [CI]: -3.0 to 2.0, P = 0.78; I (2) = 0%, 95% CI: 0 to 50) and at five minutes (RD -1.0%, 95% CI: -2.0 to 1.0, P = 0.31; I(2) = 0%, 95% CI: 0 to 50). No significant differences were found in the NACS at two hours (mean difference [MD] -0.35, 95% CI: -1.70 to 1.01, P = 0.62; I(2) = 0%, 95% CI: 0 to 79) and at 24 hr (MD -0.45, 95% CI: -1.36 to 0.46, P = 0.33; I(2) = 3%, 95% CI: 0 to 26). Also, no significant differences were found in umbilical cord artery pH (MD -0.02, 95% CI: -0.06 to 0.03, P = 0.48; I(2) = 80%, 95% CI: 46 to 92) and vein pH (MD -0.03, 95% CI: -0.07 to 0.00, P = 0.08; I(2) = 77%, 95% CI: 36 to 91). No significant publication bias was found.
  
  
  CONCLUSIONS
  The common doses of fentanyl and sufentanil used with an epidural/spinal technique in labour analgesia are safe for neonates up to 24 hr after delivery. In future studies, more attention should be paid to the long-term side effects in neonates.
authors.affiliation: Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical College, Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, 99 West Huaihai Road, Xuzhou, 221006, PR China.
authors.forename: Kai
authors.initials: K
authors.lastname: Wang
authors.forename: Liang
authors.initials: L
authors.lastname: Cao
authors.forename: Qian
authors.initials: Q
authors.lastname: Deng
authors.forename: Li-Qiang
authors.initials: LQ
authors.lastname: Sun
authors.forename: Tian-Yu
authors.initials: TY
authors.lastname: Gu
authors.forename: Jie
authors.initials: J
authors.lastname: Song
authors.forename: Dun-Yi
authors.initials: DY
authors.lastname: Qi
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000009:adverse effects*; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D017409:Sufentanil / Q000009:adverse effects
chemical_list: D000701:Analgesics, Opioid; D017409:Sufentanil; D005283:Fentanyl