PEDIATRICS Vol. 105 No. 1 January 2000, pp. 8-13

Intrapartum Maternal Fever and Neonatal Outcome

Received Jul 6, 1998; accepted Apr 19, 1999.

Ellice Lieberman^*, Janet Lang, Douglas K. Richardson^§, Fredric D. Frigoletto, Linda J. Heffner^*, and Amy Cohen^*

From the ^* Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School; the  Department of Epidemiology and Biostatistics, Boston University School of Public Health; the ^§ Joint Program for Neonatology, Harvard Medical School; and the  Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Objective.  Much of fever during term labor may not be infectious but rather a consequence of the use of epidural analgesia. Therefore, we investigated the association of elevated maternal intrapartum temperature with neonatal outcome when the infant does not develop an infection.

Methods.  We studied 1218 nulliparous women with singleton, term pregnancies in a vertex presentation and spontaneous labor. Women were excluded if their temperature was >99.5°F at admission for delivery, if they were diabetic or had an active genital herpes infection or if their infant developed a neonatal infection, had a congenital infection, or had a major malformation. Maximum intrapartum temperature was categorized as: 100.4°F (afebrile), 100.5°F to 101°F, and >101°F.

Results.  During labor, 123 women (10.1%) developed a fever >100.4°F; 62 (5.1%) women had a maximum temperature of 100.5°F to 101°F and 61 (5.0%) women had a maximum temperature >101°F. Of febrile women, 97.6% had received epidural analgesia for pain relief. Infants of women developing a fever >100.4°F were more likely to have a 1-minute Apgar score <7 (22.8% for >100.4°F vs 8.0% for afebrile) and to be hypotonic after delivery (4.8% for >100.4°F vs .5% for afebrile). Compared with infants of afebrile women, infants whose mothers' maximum temperature was >101°F were more likely to require bag and mask resuscitation (11.5% vs 3.0%) and to be given oxygen therapy in the nursery (8.2% vs 1.3%). We also found a higher rate of neonatal seizure with fever (3.3% vs .2%), but the number of infants with seizure was small (n = 4). All associations remained essentially the same after controlling for confounding in logistic regression analyses.

Conclusions.  Intrapartum maternal fever, particularly if >101°F, was associated with a number of apparently transient adverse effects in the newborn. Larger studies are needed to investigate the association of intrapartum fever with neonatal seizures and to determine whether any lasting injury to the fetus may occur.  Key words:  fever, epidural analgesia, neonatal outcome, neonatal seizures, labor.

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