PEDIATRICS Vol. 99 No. 3 March 1997, pp. 415-419
Epidural Analgesia, Intrapartum Fever, and Neonatal Sepsis Evaluation
Received Apr 16, 1996; accepted Jul 1, 1996.
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From the * Department of Obstetrics and Gynecology, Brigham and
Women's Hospital, Harvard Medical School, Boston Massachusetts; the
Department of Epidemiology and Biostatistics; Boston University
School of Public Health; the § Department of Obstetrics and Gynecology,
Massachusetts General Hospital, Harvard Medical School; and the
Joint Program in Neonatology (Brigham and Women's Hospital,
Children's Hospital, Beth Israel Hospital), Boston, Massachusetts.
Objective. Although several studies have documented an increase in maternal temperature associated with use of epidural analgesia during labor, none have investigated the impact of epidural use on the rate of intrapartum fever or the consequences for the fetus and newborn of this elevated maternal temperature. This study evaluates the impact of epidural analgesia use during labor on the rate of intrapartum fever and the performance of neonatal sepsis evaluations and treatment with antibiotics.
Methods. We studied 1657 nulliparous women with term pregnancies and singleton vertex fetuses who were afebrile at admission for delivery. The rates of maternal intrapartum fever >100.4°F, neonatal sepsis evaluation, and neonatal antibiotic treatment according to use of epidural analgesia during labor were determined. Rate ratios and 95% confidence intervals (CI) were calculated. Multiple logistic regression was used to examine associations while controlling for confounding factors.
Results. Intrapartum fever >100.4°F occurred in 14.5%
of women receiving an epidural but only 1.0% of women not receiving an
epidural (adjusted odds ratio (OR) = 14.5, 95% CI = 6.3, 33.2). Without epidural, the rate of fever remained low regardless of length
of labor; with epidural, the rate of fever increased from 7% for
labors 
6 hours to 36% for labors >18 hours. Neonates whose mothers
received epidurals were more often evaluated for sepsis (34.0% vs
9.8%; adjusted OR = 4.3, 95% CI = 3.2, 5.9) and treated with antibiotics (15.4% vs 3.8%; adjusted OR = 3.9, 95% CI = 2.1, 6.1). Although 63% of women received epidurals, 96.2% of
intrapartum fevers, 85.6% of neonatal sepsis evaluations, and 87.5%
of neonatal antibiotic treatment occurred in the epidural group.
Conclusions. Use of epidural analgesia during labor is strongly associated with the occurrence of maternal intrapartum fever, neonatal sepsis evaluations, and neonatal antibiotic treatment.
Key words: epidural analgesia, fever, neonatal sepsis, length of labor.
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