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Epidural analgesia in labour and neonatal respiratory distress: a case-control study
  1. Manoj Kumar1,
  2. Sue Chandra2,
  3. Zainab Ijaz3,
  4. Ambikaipakan Senthilselvan4
  1. 1Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
  2. 2Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
  3. 3University of Alberta, Edmonton, Alberta, Canada
  4. 4School of Public Health, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Dr Manoj Kumar, Division of Neonatology, Department of Pediatrics, Edmonton Clinical Health Academy, Room 3-528, 11405 87 Avenue NW, Edmonton, Alberta, Canada T6G 1C9; manojk{at}ualberta.ca

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.

  • case-control study
  • epidural analgesia
  • respiratory distress

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