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Low A pgar score, neonatal encephalopathy and epidural analgesia during labour: a S wedish registry‐based study
Author(s) -
TÖRNELL S.,
EKÉUS C.,
HULTIN M.,
HÅKANSSON S.,
THUNBERG J.,
HÖGBERG U.
Publication year - 2015
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12477
Subject(s) - medicine , neonatal encephalopathy , odds ratio , apgar score , encephalopathy , population , logistic regression , confidence interval , obstetrics , neonatal seizure , pregnancy , pediatrics , anesthesia , epilepsy , gestational age , environmental health , psychiatry , biology , genetics
Background Maternal intrapartum fever ( MF ) is associated with neonatal sequelae, and women in labour who receive epidural analgesia ( EA ) are more likely to develop hyperthermia. The aims of this study were to investigate if EA and/or a diagnosis of MF were associated to adverse neonatal outcomes at a population level. Methods Population‐based register study with data from the S wedish B irth R egister and the S wedish N ational P atient R egister, including all nulliparae ( n = 294,329) with singleton pregnancies who gave birth at term in S weden 1999–2008. Neonatal outcomes analysed were A pgar score ( AS ) < 7 at 5 min and ICD ‐10 diagnosis of neonatal encephalopathy (e.g. convulsions or neonatal cerebral ischaemia). Multivariate logistic regression was used to calculate adjusted odds ratios ( AOR ) with 95% confidence intervals ( CI ). Results EA was used in 44% of the deliveries. Low AS or encephalopathy was found in 1.26% and 0.39% of the children in the EA group compared with 0.80% and 0.29% in the control group. In multivariate analysis, EA was associated with increased risk with low AS , AOR 1.27 (95% CI 1.16–1.39), but not with diagnosis of encephalopathy, 1.11 (0.96–1.29). A diagnosis of MF was associated with increased risk for both low AS , 2.27 (1.71–3.02), and of neonatal encephalopathy, 1.97 (1.19–3.26). Conclusion Diagnosis of MF was associated with low AS and neonatal encephalopathy, whereas EA was only associated with low AS and not with neonatal encephalopathy. The found associations might be a result of confounding by indication, which is difficult to assess in a registry‐based population study.